Provider Demographics
NPI:1740530492
Name:BARLOW, ALLYSE DANIELLE (PA-C)
Entity type:Individual
Prefix:
First Name:ALLYSE
Middle Name:DANIELLE
Last Name:BARLOW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-7654
Mailing Address - Country:US
Mailing Address - Phone:610-730-5241
Mailing Address - Fax:
Practice Address - Street 1:1351 ROUTE 55
Practice Address - Street 2:STE 200
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5144
Practice Address - Country:US
Practice Address - Phone:845-475-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical