Healthcare Provider Details

I. General information

NPI: 1528645462
Provider Name (Legal Business Name): ALLYSON THERESE LARCENA TIPGOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HOSPITAL PLZ STE 208
OLD BRIDGE NJ
08857-3084
US

IV. Provider business mailing address

3 HOSPITAL PLZ STE 208
OLD BRIDGE NJ
08857-3084
US

V. Phone/Fax

Practice location:
  • Phone: 732-360-2700
  • Fax:
Mailing address:
  • Phone: 732-360-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number25MA13000100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: