MEDICARE: DR. JESSICA MARTINE ALLAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	221655	NY

General Provider Information

NPI Number	:	1265564751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA MARTINE ALLAN MD

Provider Business Mailing Address
First Line	:	219 W 16TH ST APT 3D
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-6029
Country	:	US
Telephone Number	:	212-247-6358
Fax Number	:	212-247-6318

Provider Business Practice Location Address
First Line	:	116 W 23RD ST STE 102
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-2599
Country	:	US
Telephone Number	:	212-247-6358
Fax Number	:	212-247-6318

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2007
Last Update Date	:	06/27/2024

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