Basic Information
| Provider Information | |||||||||
| NPI: | 1437150638 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKINNER | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RPA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FIORI | ||||||||
| OtherFirstName: | ALICIA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RPA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 20 PROSPECT ST | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | BALLSTON SPA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120201367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188853755 | ||||||||
| FaxNumber: | 5188854613 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 PROSPECT ST | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | BALLSTON SPA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120201367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188853755 | ||||||||
| FaxNumber: | 5188854613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 05/03/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 010678 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.