Provider Demographics
NPI:1083052344
Name:WASHINGTON, ALNISA FATIMA (MS ED)
Entity Type:Individual
Prefix:MS
First Name:ALNISA
Middle Name:FATIMA
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E 122ND ST APT 1101
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2051
Mailing Address - Country:US
Mailing Address - Phone:646-633-1149
Mailing Address - Fax:
Practice Address - Street 1:221 E 122ND ST APT 1101
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2051
Practice Address - Country:US
Practice Address - Phone:646-633-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY744463174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0613200001Medicare NSC
NY01479661Medicaid