Healthcare Provider Details

I. General information

NPI: 1306834486
Provider Name (Legal Business Name): ALLISON AVERILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MARKET ST
SADDLE BROOK NJ
07663-5309
US

IV. Provider business mailing address

4716 OLD GETTYSBURG RD LEGAL DEPARTMENT
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 201-368-6019
  • Fax:
Mailing address:
  • Phone: 717-972-1139
  • Fax: 717-975-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA05361200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: