Provider Demographics
NPI:1225280563
Name:ALLISON, LACRECIA ANN (R-PA-C)
Entity Type:Individual
Prefix:MISS
First Name:LACRECIA
Middle Name:ANN
Last Name:ALLISON
Suffix:
Gender:F
Credentials:R-PA-C
Other - Prefix:MISS
Other - First Name:LACRECIA
Other - Middle Name:ANN
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:R-PA-C
Mailing Address - Street 1:5645 MAIN ST
Mailing Address - Street 2:ORTHOPAEDIC 4 SOUTH
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-670-1155
Mailing Address - Fax:718-661-7281
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:4 SOUTH
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-1155
Practice Address - Fax:718-661-7281
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009353363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400000984Medicare PIN