Provider Demographics
NPI:1598727554
Name:ALLEY, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:ALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 1/2 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13108-1226
Mailing Address - Country:US
Mailing Address - Phone:315-673-9926
Mailing Address - Fax:315-673-9465
Practice Address - Street 1:28 1/2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARCELLUS
Practice Address - State:NY
Practice Address - Zip Code:13108-1226
Practice Address - Country:US
Practice Address - Phone:315-673-9926
Practice Address - Fax:315-673-9465
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196637207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02187460Medicaid
NY02187460Medicaid
NYRA1529Medicare PIN
NYRB7529Medicare PIN