Alyssa Eileen Wall, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

25MA10606100 Issued in NJ

Practice address

55 N Gilbert St Ste 2101
Tinton Falls, NJ 07701-4957

Phone

(732) 842-6677

NPI assigned

Apr 15, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jersey Shore Navesink Pediatrics

  • Pediatrics Physician
  • Red Bank, NJ
  • NPI 1497710578
  NPD (past)

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

{
    "created_epoch": "1460678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572825600000",
    "number": "1235583279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 N GILBERT ST STE 2101",
            "city": "TINTON FALLS",
            "state": "NJ",
            "postal_code": "077014957",
            "telephone_number": "732-842-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 N GILBERT ST STE 2101",
            "city": "TINTON FALLS",
            "state": "NJ",
            "postal_code": "077014957",
            "telephone_number": "732-842-6677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "ALYSSA",
        "middle_name": "EILEEN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-15",
        "last_updated": "2019-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "282NC2000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Children",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA10606100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aristotelis E Vlahos, M.D
• Volk Physical Therapy, LLC
• Janice L. Volk
• Walgreen Co
• Walgreen Co
• Nicolette Maria Wall
• Wardell Gardens Rehab Center LLC
• Kenneth B Wasser, M.D.
• Waters & Sims Employment Services Inc.
• Deborah Wayne, MS, OT

• Pediatrics Physician in Tinton Falls, NJ
• Providers in Tinton Falls, NJ by specialty
• Pediatrics Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; 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.