Healthcare Provider Details

I. General information

NPI: 1154087807
Provider Name (Legal Business Name): ALLYSON LEE THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DAVIS AVE FL 7
NEPTUNE NJ
07753-4488
US

IV. Provider business mailing address

331 NEWMAN SPRINGS RD STE 220
RED BANK NJ
07701-5792
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-3797
  • Fax: 732-776-3796
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01230500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: