Provider Demographics
NPI:1770673485
Name:BURTON ALLYN MD, PC
Entity Type:Organization
Organization Name:BURTON ALLYN MD, PC
Other - Org Name:BURTON ALLYN MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER - PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:BURTON
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLYN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-352-0500
Mailing Address - Street 1:200 E ECKERSON RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-7153
Mailing Address - Country:US
Mailing Address - Phone:845-352-0500
Mailing Address - Fax:845-425-7683
Practice Address - Street 1:200 E ECKERSON RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-7153
Practice Address - Country:US
Practice Address - Phone:845-352-0500
Practice Address - Fax:845-425-7683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY155741Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID
NYW1L681Medicare ID - Type UnspecifiedMEDICARE ORGANIZATION ID
NYC06064Medicare UPIN