Provider Demographics
NPI:1265564751
Name:ALLAN, JESSICA MARTINE (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARTINE
Last Name:ALLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:219 W 16TH ST APT 3D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6029
Mailing Address - Country:US
Mailing Address - Phone:212-247-6358
Mailing Address - Fax:212-247-6318
Practice Address - Street 1:116 W 23RD ST STE 102
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2599
Practice Address - Country:US
Practice Address - Phone:212-247-6358
Practice Address - Fax:212-247-6318
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2024-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY221655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020AU1Medicare ID - Type Unspecified
NYH50102Medicare UPIN