Provider Demographics
NPI:1073053427
Name:HANSSON, ALISON
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:HANSSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 KIRKLAND CT
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4486
Mailing Address - Country:US
Mailing Address - Phone:631-764-7303
Mailing Address - Fax:
Practice Address - Street 1:725 KIRKLAND CT
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4486
Practice Address - Country:US
Practice Address - Phone:631-764-7303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-05
Last Update Date:2017-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist