Provider Demographics
NPI:1205281920
Name:MCINERNEY, ALISSA BRETTE (MD)
Entity type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:BRETTE
Last Name:MCINERNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1434
Mailing Address - Country:US
Mailing Address - Phone:646-722-1188
Mailing Address - Fax:332-208-8071
Practice Address - Street 1:3503 31ST AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-1434
Practice Address - Country:US
Practice Address - Phone:646-722-1188
Practice Address - Fax:332-208-8071
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY298202207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program