Provider Demographics
NPI:1336397785
Name:FACHES, ALLISON L (MD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:L
Last Name:FACHES
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 ETHEL RD
Mailing Address - Street 2:SUITE 107B
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2838
Mailing Address - Country:US
Mailing Address - Phone:732-452-0057
Mailing Address - Fax:732-287-2071
Practice Address - Street 1:1 ETHEL RD
Practice Address - Street 2:SUITE 107B
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2838
Practice Address - Country:US
Practice Address - Phone:732-452-0057
Practice Address - Fax:732-287-2071
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2012-06-27
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA064798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F93246Medicare UPIN
006082Medicare PIN