Healthcare Provider Details

I. General information

NPI: 1033185327
Provider Name (Legal Business Name): ALAN DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

PO BOX 27842
NEW YORK NY
10087-7842
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1033
  • Fax:
Mailing address:
  • Phone: 718-670-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number25MA06127700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number266568
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: