Healthcare Provider Details

I. General information

NPI: 1114136967
Provider Name (Legal Business Name): ALYSON NICOLE FOX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 WEST 168TH STREET DIVISION OF GASTROENTEROLOGY AND HEPATOLOGY
NEW YORK NY
10032
US

IV. Provider business mailing address

PO BOX 27765
NEW YORK NY
10087-7765
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-0914
  • Fax: 212-305-4343
Mailing address:
  • Phone: 212-305-9576
  • Fax: 212-305-9480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number239991
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: