MEDICARE: DR. ALLEN WINTERS D.O.

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	207QA0505X	Adult Medicine Physician	105283	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	105283	OTHER	NY	NEW YORK STATE LICENSE

General Provider Information

NPI Number	:	1841511748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLEN WINTERS D.O.

Provider Business Mailing Address
First Line	:	3441 85TH STREET 3A
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372
Country	:	US
Telephone Number	:	718-446-0430
Fax Number	:

Provider Business Practice Location Address
First Line	:	3441 85TH ST APT 3A
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-3205
Country	:	US
Telephone Number	:	718-446-0430
Fax Number	:

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

Provider Enumeration Date	:	06/15/2010
Last Update Date	:	06/15/2010

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