Healthcare Provider Details

I. General information

NPI: 1326052770
Provider Name (Legal Business Name): ALLEN JOSHUA MAYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 ARLINGTON AVE
KENSINGTON CA
94707
US

IV. Provider business mailing address

38 ARLINGTON AVE
KENSINGTON CA
94707
US

V. Phone/Fax

Practice location:
  • Phone: 347-410-1028
  • Fax: 718-630-6877
Mailing address:
  • Phone: 718-630-7499
  • Fax: 718-630-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number163289
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: