Provider Demographics
NPI:1407323405
Name:RISI, ALYSSA (LAC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:RISI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 VALLEY VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-9230
Mailing Address - Country:US
Mailing Address - Phone:609-477-8461
Mailing Address - Fax:
Practice Address - Street 1:1540 WEST PARK AVENUE
Practice Address - Street 2:SUITE 4
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07712
Practice Address - Country:US
Practice Address - Phone:732-544-0011
Practice Address - Fax:732-544-1115
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-28
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty