Provider Demographics
NPI:1083780514
Name:ALLEN, LINCOLN DARIUS (PA)
Entity Type:Individual
Prefix:MR
First Name:LINCOLN
Middle Name:DARIUS
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 PALISADE AVE
Mailing Address - Street 2:SUITE#1C
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2924
Mailing Address - Country:US
Mailing Address - Phone:914-377-1191
Mailing Address - Fax:
Practice Address - Street 1:785 WESTCHESTER AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455
Practice Address - Country:US
Practice Address - Phone:718-589-5500
Practice Address - Fax:718-589-1096
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000366363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02818000Medicaid