Provider Demographics
NPI:1003869850
Name:DR MARC ALLEN MEDICAL PC
Entity Type:Organization
Organization Name:DR MARC ALLEN MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-543-8844
Mailing Address - Street 1:358 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 11
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725
Mailing Address - Country:US
Mailing Address - Phone:631-543-8844
Mailing Address - Fax:631-543-8840
Practice Address - Street 1:358 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE 11
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725
Practice Address - Country:US
Practice Address - Phone:631-543-8844
Practice Address - Fax:631-543-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2238341207R00000X
NY2363742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02238341Medicaid
H63005Medicare UPIN
NY02238341Medicaid