Provider Demographics
NPI:1609965409
Name:LOGERQUIST, ALLEN A (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:A
Last Name:LOGERQUIST
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 1:20 BEEKMAN PL
Mailing Address - Street 2:APT 2D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-8076
Mailing Address - Country:US
Mailing Address - Phone:212-777-4028
Mailing Address - Fax:212-777-4064
Practice Address - Street 1:20 BEEKMAN PL
Practice Address - Street 2:APT 2D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-8076
Practice Address - Country:US
Practice Address - Phone:212-777-4028
Practice Address - Fax:212-777-4064
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY104850207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY290931Medicare ID - Type Unspecified
NYB12374Medicare UPIN