Provider Demographics
NPI:1497194641
Name:KESSER, ALLA
Entity type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:KESSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLA
Other - Middle Name:
Other - Last Name:SKRYZHYNSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1055 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1336
Mailing Address - Country:US
Mailing Address - Phone:646-288-7732
Mailing Address - Fax:
Practice Address - Street 1:1055 E BROADWAY
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1336
Practice Address - Country:US
Practice Address - Phone:646-288-7732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY738369131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist