Provider Demographics
NPI:1801218714
Name:BRISTOL, ALLISON
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:BRISTOL
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 1:58 PATRICIA LN
Mailing Address - Street 2:402
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-4200
Mailing Address - Country:US
Mailing Address - Phone:917-415-0644
Mailing Address - Fax:
Practice Address - Street 1:58 PATRICIA LN
Practice Address - Street 2:402
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-4200
Practice Address - Country:US
Practice Address - Phone:917-415-0644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-11
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301256-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse