Provider Demographics
NPI:1659487064
Name:BEYDA, ALLAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:E
Last Name:BEYDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 23 59TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-359-7406
Mailing Address - Fax:718-359-2592
Practice Address - Street 1:141 23 59TH AVENUE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-359-7406
Practice Address - Fax:718-359-2592
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136569207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00430497Medicaid
E39704Medicare UPIN
NY00430497Medicaid