Provider Demographics
NPI:1134536311
Name:KUBASEK, ALLYSON E (PA-C)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:E
Last Name:KUBASEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:
Other - Last Name:RIPKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32 SEYMOUR STREET
Mailing Address - Street 2:HARTFORD HOSPITAL ORTHOPEDICS DEPT
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-972-2245
Mailing Address - Fax:
Practice Address - Street 1:32 SEYMOUR STREET
Practice Address - Street 2:HARTFORD HOSPITAL ORTHOPEDICS DEPT
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06102-5037
Practice Address - Country:US
Practice Address - Phone:860-972-2245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-19
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3191363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical