Provider Demographics
NPI:1841625084
Name:ALLISON, GREG TYLER (MD)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:TYLER
Last Name:ALLISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CENTRAL AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-4202
Mailing Address - Country:US
Mailing Address - Phone:201-207-1052
Mailing Address - Fax:
Practice Address - Street 1:250 CENTRAL AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-4202
Practice Address - Country:US
Practice Address - Phone:201-207-1052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital