MEDICARE: MS. ALLYN A SISON RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	40QA01137600	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00313564	OTHER	NJ	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1659466241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALLYN A SISON RPT

Provider Business Mailing Address
First Line	:	1175 ROOSEVELT AVE.
Second Line	:
City	:	CARTERET
State	:	NJ
Zip	:	07008-0536
Country	:	US
Telephone Number	:	732-541-2233
Fax Number	:	732-541-2234

Provider Business Practice Location Address
First Line	:	266 HARRISTOWN RD STE 304
Second Line	:
City	:	GLEN ROCK
State	:	NJ
Zip	:	07452-3321
Country	:	US
Telephone Number	:	201-857-0527
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	10/20/2020

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