Provider Demographics
NPI:1376946426
Name:ALYSSA DAVIS INC.
Entity Type:Organization
Organization Name:ALYSSA DAVIS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEIG
Authorized Official - Suffix:
Authorized Official - Credentials:LBCBA
Authorized Official - Phone:646-741-3748
Mailing Address - Street 1:39 LORI WAY
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4301
Mailing Address - Country:US
Mailing Address - Phone:917-842-6189
Mailing Address - Fax:
Practice Address - Street 1:39 LORI WAY
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4301
Practice Address - Country:US
Practice Address - Phone:917-842-6189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10300000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDOtherAUTISM PROVIDER
NY10300000OtherHEALTH CARE