Individual
ALLISON TIEDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
65 PARK AVE, BLUE POINT, NY 11715-1040
(631) 512-2665
Mailing address
65 PARK AVE, BLUE POINT, NY 11715-1040
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
08/08/2018
Last updated
08/08/2018
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