Provider Demographics
NPI:1265626642
Name:ALLISON, STEFANIE LYN (DO)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:LYN
Last Name:ALLISON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-783-2700
Mailing Address - Fax:
Practice Address - Street 1:101 JORDAN RD STE 200
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-8337
Practice Address - Country:US
Practice Address - Phone:518-274-0476
Practice Address - Fax:518-274-0497
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245834207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02914189Medicaid
NYRB5766Medicare PIN