Provider Demographics
NPI:1871082586
Name:GRACIE, ALLYSON K (DACM, LAC)
Entity type:Individual
Prefix:DR
First Name:ALLYSON
Middle Name:K
Last Name:GRACIE
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 WEST END AVE APT G12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3561
Mailing Address - Country:US
Mailing Address - Phone:164-624-2573
Mailing Address - Fax:
Practice Address - Street 1:928 BROADWAY STE 401
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8150
Practice Address - Country:US
Practice Address - Phone:646-242-5733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00631171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist