Provider Demographics
NPI:1023418969
Name:LEOPOLD ALLEN
Entity type:Organization
Organization Name:LEOPOLD ALLEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MR
Authorized Official - First Name:LEOPOLD
Authorized Official - Middle Name:W
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:914-843-0270
Mailing Address - Street 1:100 EINSTEIN LOOP
Mailing Address - Street 2:APT5E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4947
Mailing Address - Country:US
Mailing Address - Phone:914-843-0270
Mailing Address - Fax:
Practice Address - Street 1:100 EINSTEIN LOOP
Practice Address - Street 2:APT 5E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475
Practice Address - Country:US
Practice Address - Phone:914-843-0270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319324-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherMEDICAID NUMBER
NY=========OtherMEDICAID