Provider Demographics
NPI:1093875965
Name:MORGAN, ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 HIGHWAY 70
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5897
Mailing Address - Country:US
Mailing Address - Phone:732-363-0907
Mailing Address - Fax:732-363-2004
Practice Address - Street 1:475 HIGHWAY 70
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5897
Practice Address - Country:US
Practice Address - Phone:732-363-0907
Practice Address - Fax:732-363-2004
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05683100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE93669Medicare UPIN
NJMO164551Medicare ID - Type Unspecified