Healthcare Provider Details

I. General information

NPI: 1689211351
Provider Name (Legal Business Name): ALLISON NOAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 HIGHLAND AVE
LONG BRANCH NJ
07740-4649
US

IV. Provider business mailing address

PO BOX 74
DEAL NJ
07723-0074
US

V. Phone/Fax

Practice location:
  • Phone: 732-616-3174
  • Fax:
Mailing address:
  • Phone: 732-616-3174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number26NR19877500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: