Basic Information
| Provider Information | |||||||||
| NPI: | 1659466241 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SISON | ||||||||
| FirstName: | ALLYN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1175 ROOSEVELT AVE. | ||||||||
| Address2: | |||||||||
| City: | CARTERET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070080536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325412233 | ||||||||
| FaxNumber: | 7325412234 | ||||||||
| Practice Location | |||||||||
| Address1: | 266 HARRISTOWN RD STE 304 | ||||||||
| Address2: | |||||||||
| City: | GLEN ROCK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074523321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018570527 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 10/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 40QA01137600 | NJ | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | P00313564 | 01 | NJ | RAILROAD MEDICARE | OTHER |