Provider Demographics
NPI:1932434412
Name:LUDWIN, ALYSSA F (PA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:F
Last Name:LUDWIN
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 1:21 READE PL STE 3200
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3944
Mailing Address - Country:US
Mailing Address - Phone:845-471-4086
Mailing Address - Fax:845-471-8296
Practice Address - Street 1:21 READE PL STE 3200
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3944
Practice Address - Country:US
Practice Address - Phone:845-471-4086
Practice Address - Fax:845-471-8296
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000000363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400019166Medicare UPIN