Provider Demographics
NPI:1023264363
Name:DOUGLAS ALLEN, DO PC
Entity type:Organization
Organization Name:DOUGLAS ALLEN, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SADIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-245-7900
Mailing Address - Street 1:425 MADISON AVE
Mailing Address - Street 2:11TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 MADISON AVE
Practice Address - Street 2:11TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-245-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235254208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty