Healthcare Provider Details

I. General information

NPI: 1982010260
Provider Name (Legal Business Name): JENNIFER DYANE ALLEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

580 SAINT NICHOLAS AVE APT 4H
NEW YORK NY
10030-1932
US

V. Phone/Fax

Practice location:
  • Phone: 212-343-8530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number649661
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF382526-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: