Individual
ALYSSA EILEEN WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
55 N GILBERT ST STE 2101, TINTON FALLS, NJ 07701-4957
(732) 842-6677
Mailing address
55 N GILBERT ST STE 2101, TINTON FALLS, NJ 07701-4957
(732) 842-6677
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
25MA10606100
NJ
282NC2000X
Children's Hospital
—
—
Other
Enumeration date
04/15/2016
Last updated
11/04/2019
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