Provider Demographics
NPI:1659645778
Name:IMPARATO, ALYSSA (SETSS)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:IMPARATO
Suffix:
Gender:F
Credentials:SETSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 SUMMIT STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231
Mailing Address - Country:US
Mailing Address - Phone:516-644-1193
Mailing Address - Fax:
Practice Address - Street 1:99 ESSEX ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-3207
Practice Address - Country:US
Practice Address - Phone:212-566-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY594475121390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program