Provider Demographics
NPI:1679926539
Name:PEREZ, ALLYSSA VENDIOLA
Entity Type:Individual
Prefix:MS
First Name:ALLYSSA
Middle Name:VENDIOLA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ALLYSSA
Other - Middle Name:VENDIOLA
Other - Last Name:AQUINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 LETHBRIDGE PLZ STE 20
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2114
Mailing Address - Country:US
Mailing Address - Phone:609-474-0120
Mailing Address - Fax:609-474-0121
Practice Address - Street 1:137 HIGH ST FL 2A
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1476
Practice Address - Country:US
Practice Address - Phone:609-474-0120
Practice Address - Fax:609-474-0121
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY716134163W00000X
NJ26NJ00953400363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner