Provider Demographics
NPI:1891733010
Name:EMMONS, ALYSON (DO)
Entity Type:Individual
Prefix:DR
First Name:ALYSON
Middle Name:
Last Name:EMMONS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:
Other - Last Name:EMMONS-ABBRUZZI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:100 BOWMAN DR
Practice Address - Street 2:VIRTUA HOSPITAL
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9612
Practice Address - Country:US
Practice Address - Phone:856-782-3300
Practice Address - Fax:856-504-8029
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08622900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356Medicare Oscar/Certification
165155SK3Medicare PIN