Provider Demographics
NPI:1427225689
Name:JESSICA ALLAN MD PC
Entity Type:Organization
Organization Name:JESSICA ALLAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIR.
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-247-6358
Mailing Address - Street 1:219 W 16TH ST APT 3D
Mailing Address - Street 2:10011-6029
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6029
Mailing Address - Country:US
Mailing Address - Phone:212-247-6358
Mailing Address - Fax:
Practice Address - Street 1:333 W 57TH ST APT 104
Practice Address - Street 2:SUITE 4A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3115
Practice Address - Country:US
Practice Address - Phone:212-247-6358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1265564751OtherINDIVIDUAL NPI
NY1427225689OtherGROUP NPI