Healthcare Provider Details

I. General information

NPI: 1306426226
Provider Name (Legal Business Name): ALYSSA P KESSEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONTAUK HWY # 11795
WEST ISLIP NY
11795-4927
US

IV. Provider business mailing address

1000 MONTAUK HWY # 11795
WEST ISLIP NY
11795-4927
US

V. Phone/Fax

Practice location:
  • Phone: 631-376-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: