Provider Demographics
NPI:1619415205
Name:ALLIED PHYSICIANS GROUP
Entity Type:Organization
Organization Name:ALLIED PHYSICIANS GROUP
Other - Org Name:WELL CARE PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ALYSON
Authorized Official - Last Name:SAIKUM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:516-807-1058
Mailing Address - Street 1:19916 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1906
Mailing Address - Country:US
Mailing Address - Phone:516-807-1058
Mailing Address - Fax:
Practice Address - Street 1:1720 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3247
Practice Address - Country:US
Practice Address - Phone:718-939-4379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:N/A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty