Provider Demographics
NPI:1669450375
Name:NATOW, ALLEN JAY (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:JAY
Last Name:NATOW
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 1:949 CENTRAL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1204
Mailing Address - Country:US
Mailing Address - Phone:516-295-1921
Mailing Address - Fax:516-295-9304
Practice Address - Street 1:949 CENTRAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1204
Practice Address - Country:US
Practice Address - Phone:516-295-1921
Practice Address - Fax:516-295-9304
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154618207N00000X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAN060D0310OtherBLUE CROSS
NYAN060D0310OtherBLUE CROSS
60D0319181Medicare PIN