Individual
MRS. ALISA STEPHANIE GOULBOURNE-SCOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
19 HENRIETTA CT, RIDGEWOOD, NJ 07450-2938
(201) 670-7498
Mailing address
19 HENRIETTA CT, RIDGEWOOD, NJ 07450-2938
(201) 670-7498
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0041901
NY
Other
Enumeration date
04/23/2007
Last updated
09/14/2007
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