Provider Demographics
NPI:1235573064
Name:SCHRODER, ALLISON (ALLISON SCHRODER)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:
Last Name:SCHRODER
Suffix:
Gender:F
Credentials:ALLISON SCHRODER
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:SCHRODER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ALLISON SCHRODER
Mailing Address - Street 1:1112 SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4462
Mailing Address - Country:US
Mailing Address - Phone:631-654-2245
Mailing Address - Fax:
Practice Address - Street 1:335 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-1143
Practice Address - Country:US
Practice Address - Phone:631-654-2245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2093673174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist