Provider Demographics
NPI:1013999812
Name:ALLEN, GIL C (DC, PHD, CDN)
Entity Type:Individual
Prefix:DR
First Name:GIL
Middle Name:C
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DC, PHD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6505
Mailing Address - Country:US
Mailing Address - Phone:718-461-7788
Mailing Address - Fax:718-461-3343
Practice Address - Street 1:14201 37TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6505
Practice Address - Country:US
Practice Address - Phone:718-461-7788
Practice Address - Fax:718-461-3343
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1512111NX0800X
NY3769133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01721379Medicaid
NY01721379Medicaid