Provider Demographics
NPI:1700275807
Name:ICOLARI, ALYSSA MARIE (MS)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:MARIE
Last Name:ICOLARI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4304
Mailing Address - Country:US
Mailing Address - Phone:973-454-8466
Mailing Address - Fax:
Practice Address - Street 1:255 ROUTE 32
Practice Address - Street 2:
Practice Address - City:CENTRAL VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10917-3613
Practice Address - Country:US
Practice Address - Phone:845-827-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist