Individual
ALLISON TYSKA-PETTERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 SCOUTING BLVD, MEDFORD, NY 11763-2220
(631) 297-3200
Mailing address
711 GREGORY PL, RIVERHEAD, NY 11901-2904
(631) 830-7452
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1751576
NY
Other
Enumeration date
06/08/2012
Last updated
06/08/2012
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