Healthcare Provider Details

I. General information

NPI: 1235961715
Provider Name (Legal Business Name): ALLYSON NOEL LINCER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 FOREST AVE
STATEN ISLAND NY
10303-2127
US

IV. Provider business mailing address

309 CINDY ST
OLD BRIDGE NJ
08857-1866
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-2000
  • Fax:
Mailing address:
  • Phone: 917-846-2764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number570725-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: