Provider Demographics
NPI:1275634008
Name:PACK, ALISON M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:M
Last Name:PACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 W 168TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2699
Mailing Address - Country:US
Mailing Address - Phone:212-305-1742
Mailing Address - Fax:212-305-5445
Practice Address - Street 1:710 W 168TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2699
Practice Address - Country:US
Practice Address - Phone:212-305-1742
Practice Address - Fax:212-305-5445
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210836-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02101820Medicaid
NY03S211Medicare ID - Type Unspecified
NYH25049Medicare UPIN