Provider Demographics
NPI:1144472382
Name:DHAENE, ALLISON (PA)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:
Last Name:DHAENE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:GORENFLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:
Practice Address - Street 1:300 HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-2263
Practice Address - Country:US
Practice Address - Phone:607-734-4110
Practice Address - Fax:607-734-0344
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012913363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03524132Medicaid
NY03524132Medicaid