Allison Tyska-Pettersen

Primary specialty

SpecialistTaxonomy code 174400000X

License

1751576 Issued in NY

Practice address

1 Scouting Blvd
Medford, NY 11763-2220

Phone

(631) 297-3200

NPI assigned

Jun 8, 2012

Last updated

Jun 8, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339113600000",
    "number": "1093077737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 GREGORY PL",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012904",
            "telephone_number": "631-830-7452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SCOUTING BLVD",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117632220",
            "telephone_number": "631-297-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYSKA-PETTERSEN",
        "first_name": "ALLISON",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-08",
        "last_updated": "2012-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "1751576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Medford, NY
• Providers in Medford, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.