Provider Demographics
NPI:1922445196
Name:LUSKI, ALLYSON GRACE
Entity Type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:GRACE
Last Name:LUSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ALLYSON
Other - Middle Name:GRACE
Other - Last Name:APOLLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:23 HILLTOP TERRACE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07403
Mailing Address - Country:US
Mailing Address - Phone:201-566-6503
Mailing Address - Fax:
Practice Address - Street 1:23 HILLTOP TER
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07403-1509
Practice Address - Country:US
Practice Address - Phone:201-566-6503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00439800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner