1225280563 NPI number — MISS LACRECIA ANN ALLISON R-PA-C

Table of content: MISS LACRECIA ANN ALLISON R-PA-C (NPI 1225280563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225280563 NPI number — MISS LACRECIA ANN ALLISON R-PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLISON
Provider First Name:
LACRECIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
R-PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALLISON
Provider Other First Name:
LACRECIA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
R-PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225280563
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5645 MAIN ST
Provider Second Line Business Mailing Address:
ORTHOPAEDIC 4 SOUTH
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11355-5045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-670-1155
Provider Business Mailing Address Fax Number:
718-661-7281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5645 MAIN ST
Provider Second Line Business Practice Location Address:
4 SOUTH
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11355-5045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-670-1155
Provider Business Practice Location Address Fax Number:
718-661-7281
Provider Enumeration Date:
10/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  009353 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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