Provider Demographics
NPI:1003213992
Name:SNOW, ALICIA J (PA-C)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:J
Last Name:SNOW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E FAIRMOUNT AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14750-1948
Mailing Address - Country:US
Mailing Address - Phone:716-526-1183
Mailing Address - Fax:716-526-1165
Practice Address - Street 1:133 E FAIRMOUNT AVENUE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NY
Practice Address - Zip Code:14750-1948
Practice Address - Country:US
Practice Address - Phone:716-526-1183
Practice Address - Fax:716-526-1165
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018188-1363A00000X
NY18188363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04098757Medicaid