Healthcare Provider Details

I. General information

NPI: 1083855332
Provider Name (Legal Business Name): ALLISON R WAGREICH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MADISON AVE # 109 WOMEN'S CANCER CENTER
MORRISTOWN NJ
07960-6136
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-5900
  • Fax: 973-290-7257
Mailing address:
  • Phone: 973-656-6280
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number25MA07628100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number228184
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: