Basic Information
| Provider Information | |||||||||
| NPI: | 1679065726 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOTTER | ||||||||
| FirstName: | ALYSSA | ||||||||
| MiddleName: | KAI | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 OAKRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | ANNANDALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088013380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082401107 | ||||||||
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| Practice Location | |||||||||
| Address1: | 29 E 29TH ST | ||||||||
| Address2: | |||||||||
| City: | BAYONNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070024654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018585000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2018 | ||||||||
| LastUpdateDate: | 11/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.