Provider Demographics
NPI:1114024353
Name:ALLAN, ROBERT (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ALLAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E 72ND ST
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4684
Mailing Address - Country:US
Mailing Address - Phone:212-831-3131
Mailing Address - Fax:212-831-3131
Practice Address - Street 1:311 E 72ND ST
Practice Address - Street 2:SUITE 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4684
Practice Address - Country:US
Practice Address - Phone:212-831-3131
Practice Address - Fax:212-831-3131
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4916103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV52661Medicare ID - Type Unspecified