Provider Demographics
NPI:1588730816
Name:ALCUS, PATRICIA E (NP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E
Last Name:ALCUS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:DWYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:300 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:GREENPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11944-1203
Mailing Address - Country:US
Mailing Address - Phone:631-477-1871
Mailing Address - Fax:631-477-0219
Practice Address - Street 1:300 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:GREENPORT
Practice Address - State:NY
Practice Address - Zip Code:11944-1203
Practice Address - Country:US
Practice Address - Phone:631-477-1871
Practice Address - Fax:631-477-0219
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420040-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA71829OtherMDNY
NY040426011111OtherFIDELIS
NYP3603456OtherOXFORD
NY1000044671OtherAFFINITY
NY100194912101OtherUNITED HLTHCRE-MD,CHP,FHP
NY01572132Medicaid
NY113432OtherVYTRA
NY1000044671OtherAFFINITY
NY01572132Medicaid