Provider Demographics
NPI:1497015945
Name:HAJ, ALYSSA JUSTINE
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JUSTINE
Last Name:HAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4164 N BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2415
Mailing Address - Country:US
Mailing Address - Phone:716-240-2100
Mailing Address - Fax:716-825-3645
Practice Address - Street 1:4164 N BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2415
Practice Address - Country:US
Practice Address - Phone:716-240-2100
Practice Address - Fax:716-825-3645
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025783225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist