Healthcare Provider Details

I. General information

NPI: 1982113692
Provider Name (Legal Business Name): MR. PETER ANTHONY ALLEN II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

598 BROADWAY 2ND FLOOR
NEW YORK NY
10012
US

IV. Provider business mailing address

598 BROADWAY FL 2
NEW YORK NY
10012-3363
US

V. Phone/Fax

Practice location:
  • Phone: 212-966-9537
  • Fax:
Mailing address:
  • Phone: 212-966-9537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: