Healthcare Provider Details

I. General information

NPI: 1063026771
Provider Name (Legal Business Name): ALYSSA JEAN T NUESA CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 STATE ROUTE 27 STE 1100
SOMERSET NJ
08873-3979
US

IV. Provider business mailing address

42 COOLIDGE AVE
EDISON NJ
08837-2852
US

V. Phone/Fax

Practice location:
  • Phone: 732-545-4066
  • Fax:
Mailing address:
  • Phone: 732-425-1473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278P1005X
TaxonomyPulmonary Rehabilitation Certified Respiratory Therapist
License Number43ZA00680500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: