Provider Demographics
NPI:1467875708
Name:PUORRO, ALYSSA (DC, RDN)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:
Last Name:PUORRO
Suffix:
Gender:F
Credentials:DC, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CAMBRAY ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045
Mailing Address - Country:US
Mailing Address - Phone:973-747-4229
Mailing Address - Fax:
Practice Address - Street 1:20 CAMBRAY ROAD
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045
Practice Address - Country:US
Practice Address - Phone:973-747-4229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2023-01-03
Deactivation Date:2015-07-14
Deactivation Code:
Reactivation Date:2020-02-03
Provider Licenses
StateLicense IDTaxonomies
GACHIR010178111N00000X
NJ1085029133V00000X
NJ38MC00766200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered