Healthcare Provider Details

I. General information

NPI: 1366481202
Provider Name (Legal Business Name): ALLA VOL P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 92ND ST
BROOKLYN NY
11228-3619
US

IV. Provider business mailing address

29 W 34TH ST 4TH FLOOR
NEW YORK NY
10001-3007
US

V. Phone/Fax

Practice location:
  • Phone: 212-563-2497
  • Fax: 212-563-0605
Mailing address:
  • Phone: 212-563-2497
  • Fax: 212-563-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number008081
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number008081
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: