Provider Demographics
NPI:1750554127
Name:ALLEN S. KIRK
Entity type:Organization
Organization Name:ALLEN S. KIRK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-728-2211
Mailing Address - Street 1:1485 UNION VALLEY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-1336
Mailing Address - Country:US
Mailing Address - Phone:973-728-2211
Mailing Address - Fax:973-728-2237
Practice Address - Street 1:1485 UNION VALLEY RD
Practice Address - Street 2:SUITE C
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-1336
Practice Address - Country:US
Practice Address - Phone:973-728-2211
Practice Address - Fax:973-728-2237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01471213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0804290001Medicare NSC