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NPI Code Detail

MEDICARE: THEODORE ELIAS ALLEN M.D.

MEDICARE: THEODORE ELIAS ALLEN M.D.
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
1207R00000XInternal Medicine Physician129095NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659379147
Entity Type Code : Individual
Provider Name (Legal Business Name) : THEODORE ELIAS ALLEN M.D.
Provider Business Mailing Address
First Line : 3198 GRAND CONCOURSE
Second Line :
City : BRONX
State : NY
Zip : 10458-1000
Country : US
Telephone Number : 718-618-0401
Fax Number : 718-795-4394
Provider Business Practice Location Address
First Line : 2015 GRAND CONCOURSE
Second Line :
City : BRONX
State : NY
Zip : 10453-4303
Country : US
Telephone Number : 718-299-7295
Fax Number : 718-299-6797
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2005
Last Update Date : 06/13/2016

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