Healthcare Provider Details

I. General information

NPI: 1609368406
Provider Name (Legal Business Name): ALYSSA MIRA WOHL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

794 UNION ST
BROOKLYN NY
11215-7583
US

IV. Provider business mailing address

1 EMBARCADERO CTR STE 1900
SAN FRANCISCO CA
94111-3723
US

V. Phone/Fax

Practice location:
  • Phone: 212-624-1077
  • Fax: 415-252-7176
Mailing address:
  • Phone: 415-658-6791
  • Fax: 415-520-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number309069
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: