Provider Demographics
NPI:1982750303
Name:GUGLIELMO, ALYSSA M (DC, CACCP)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:M
Last Name:GUGLIELMO
Suffix:
Gender:F
Credentials:DC, CACCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SWEET BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2118
Mailing Address - Country:US
Mailing Address - Phone:917-697-0864
Mailing Address - Fax:
Practice Address - Street 1:63 MAIN ST
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-2118
Practice Address - Country:US
Practice Address - Phone:917-697-0864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011224111N00000X
NJ38MC00697800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor