Provider Demographics
NPI:1790927259
Name:HERGIANTO, ALISON BERKOWITZ (ANP)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:BERKOWITZ
Last Name:HERGIANTO
Suffix:
Gender:F
Credentials:ANP
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Mailing Address - Street 1:100 E 53RD ST
Mailing Address - Street 2:MEMORIAL SLOAN KETTERING CANCER CENTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6016
Mailing Address - Country:US
Mailing Address - Phone:646-888-4203
Mailing Address - Fax:646-888-4262
Practice Address - Street 1:160 E 53RD ST
Practice Address - Street 2:MEMORIAL SLOAN KETTERING CANCER CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5243
Practice Address - Country:US
Practice Address - Phone:646-888-4203
Practice Address - Fax:646-888-4262
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY305065363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMB1942374OtherDEA