Active NPI
Alicia Taylor Brustein, PA
- Medical Physician Assistant
- Camp Hill, PA
National Provider Identifier
1639609696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- MA060420
- Practice address
- 425 North 21St Street
Suite 405
Camp Hill, PA 17011 - Phone
- (717) 695-6553
- Fax
- (855) 383-3233
- NPI assigned
- Jun 13, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | OA004204 | PA | |
| Surgical Physician Assistant | 363AS0400X | MA060420 | PA | |
| Medical Physician Assistant | 363AM0700X | MA060420 | PA | Primary |
Addresses
Primary practice location
425 North 21St Street
Suite 405
Camp Hill, PA 17011
Mailing address
425 North 21St Street
Suite 405
Camp Hill, PA 17011
Phone (717) 695-6553
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MA060420 | Other | PA | NEW LICENSE NUMBER |
| 103340644 | Medicaid | PA |
Other names 1
- Ms. Alicia Taylor Garbade
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OA004204 | PA | MD | Physician Assistant |
| MA060420 | PA | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564531200000",
"number": "1639609696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "425 NORTH 21ST STREET",
"address_2": "SUITE 405",
"city": "CAMP HILL",
"state": "PA",
"postal_code": "17011",
"telephone_number": "717-695-6553",
"fax_number": "855-383-3233"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 NORTH 21ST STREET",
"address_2": "SUITE 405",
"city": "CAMP HILL",
"state": "PA",
"postal_code": "17011",
"telephone_number": "717-695-6553",
"fax_number": "855-383-3233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUSTEIN",
"first_name": "ALICIA",
"middle_name": "TAYLOR",
"name_prefix": "Mrs.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-13",
"last_updated": "2019-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "OA004204",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "PA",
"license": "MA060420",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "PA",
"license": "MA060420",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW LICENSE NUMBER",
"identifier": "MA060420",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "103340644",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ALICIA",
"last_name": "GARBADE",
"middle_name": "TAYLOR",
"prefix": "MS.",
"credential": "PA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Camp Hill, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.