Provider Demographics
NPI:1831801414
Name:CRISCUOLO, ALYSSA ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANNE
Last Name:CRISCUOLO
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 1:95 MOHAWK TRL
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-2950
Mailing Address - Country:US
Mailing Address - Phone:973-934-8187
Mailing Address - Fax:
Practice Address - Street 1:350 ENGLE ST RM 4503
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1808
Practice Address - Country:US
Practice Address - Phone:201-894-3893
Practice Address - Fax:201-894-3764
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00746400363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical