Provider Demographics
NPI:1669870325
Name:GOPMAN, ALYSSA (PA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:GOPMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WILLIAM ST APT 14G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-2932
Mailing Address - Country:US
Mailing Address - Phone:561-635-7882
Mailing Address - Fax:
Practice Address - Street 1:117 E 18TH ST FRNT 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2113
Practice Address - Country:US
Practice Address - Phone:212-673-5633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018289363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical