Provider Demographics
NPI:1659466241
Name:SISON, ALLYN A (RPT)
Entity Type:Individual
Prefix:MS
First Name:ALLYN
Middle Name:A
Last Name:SISON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 ROOSEVELT AVE.
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-0536
Mailing Address - Country:US
Mailing Address - Phone:732-541-2233
Mailing Address - Fax:732-541-2234
Practice Address - Street 1:266 HARRISTOWN RD STE 304
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-3321
Practice Address - Country:US
Practice Address - Phone:201-857-0527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01137600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00313564OtherRAILROAD MEDICARE
NJP00313564OtherRAILROAD MEDICARE