Healthcare Provider Details

I. General information

NPI: 1982152773
Provider Name (Legal Business Name): ALLYSON BROOKE RAKER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WESTCHESTER AVE
WHITE PLAINS NY
10604-2901
US

IV. Provider business mailing address

800 WESTCHESTER AVE
RYE BROOK NY
10573-1354
US

V. Phone/Fax

Practice location:
  • Phone: 914-681-3100
  • Fax: 914-682-6588
Mailing address:
  • Phone: 914-607-5730
  • Fax: 914-457-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5018
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number23020150
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: