Provider Demographics
NPI:1619078227
Name:KIRK, ALLEN SCOTT (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:SCOTT
Last Name:KIRK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485C UNION VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480
Mailing Address - Country:US
Mailing Address - Phone:973-728-2211
Mailing Address - Fax:973-728-2237
Practice Address - Street 1:1485 UNION VALLEY RD STE C
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-1317
Practice Address - Country:US
Practice Address - Phone:973-728-2211
Practice Address - Fax:973-728-2237
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01471213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1097903Medicaid
NJ1097903Medicaid
NJ484790Medicare PIN