Provider Demographics
NPI:1144790049
Name:ALLEN, DONALD RICHARD (LAC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:RICHARD
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 58TH ST BSMT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3609
Mailing Address - Country:US
Mailing Address - Phone:718-290-2919
Mailing Address - Fax:718-290-9860
Practice Address - Street 1:833 58TH ST BSMT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3609
Practice Address - Country:US
Practice Address - Phone:718-290-2919
Practice Address - Fax:718-290-9860
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006429171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist