Allison Wallace

NPI #1376921718 in Lido Beach, New York

Provider Information

NPI Number: 1376921718
Entity Type: Individual
Name: Allison Wallace
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Contractor
Enumeration Date: May 18, 2015
Last Updated: May 18, 2015

Practice Location

Address: 453 LIDO BLVD
City: Lido Beach
State: New York
ZIP Code: 11561-5107
Phone: (516) 680-3741

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Contractor	171W00000X	Primary

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