MEDICARE: ALISSA PIRAK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA01587900	NJ

General Provider Information

NPI Number	:	1154891760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISSA PIRAK

Provider Business Mailing Address
First Line	:	182 BOULEVARD
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-1826
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	182 BOULEVARD
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-1826
Country	:	US
Telephone Number	:	201-288-4950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2018
Last Update Date	:	11/27/2018

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Directions to “ ALISSA PIRAK ” Practice Location

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