Provider Demographics
NPI:1396811071
Name:GIMELBERG, ALEXANDER Y (PA)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:Y
Last Name:GIMELBERG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1070
Mailing Address - Street 2:PRIMA CARE, PC
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-1070
Mailing Address - Country:US
Mailing Address - Phone:508-676-3292
Mailing Address - Fax:508-672-7181
Practice Address - Street 1:289 PLEASANT ST
Practice Address - Street 2:PRIMA CARE, PC
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3005
Practice Address - Country:US
Practice Address - Phone:508-646-7645
Practice Address - Fax:508-646-7641
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2016-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA759363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q51535Medicare UPIN