Provider Demographics
NPI:1841595097
Name:WICKER, ALEXANDER JASON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:JASON
Last Name:WICKER
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:24 CARRIAGE RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3118
Mailing Address - Country:US
Mailing Address - Phone:516-741-2998
Mailing Address - Fax:
Practice Address - Street 1:133 E MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5900
Practice Address - Country:US
Practice Address - Phone:516-887-5500
Practice Address - Fax:516-887-5509
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2020-08-20
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant