Provider Demographics
NPI:1851320212
Name:ALLEN, JUDITH (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 278980
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:995 SENATOR KEATING BLVD
Practice Address - Street 2:SUITE 200 BUILDING E
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2775
Practice Address - Country:US
Practice Address - Phone:585-244-8817
Practice Address - Fax:585-279-3612
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176480207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE87851Medicare UPIN
NYJ400004013Medicare PIN
NYDD0191Medicare PIN