Provider Demographics
NPI:1285808824
Name:IPSON, ALAN VESTEN
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:VESTEN
Last Name:IPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ORTHOPEDIC SERVICES OF CMA
Mailing Address - Street 2:16 BRENTWOOD DRIVE
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-272-7000
Mailing Address - Fax:607-272-4604
Practice Address - Street 1:ORTHOPEDIC SERVICES OF CMA
Practice Address - Street 2:16 BRENTWOOD DRIVE
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-272-7000
Practice Address - Fax:607-272-4604
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012764363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03308514Medicaid
NYJ400001787Medicare PIN
NY03308514Medicaid