1356380489 NPI number — DR. ELIZABETH ALLEN MD

Table of content: DR. ELIZABETH ALLEN MD (NPI 1356380489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356380489 NPI number — DR. ELIZABETH ALLEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
ELIZABETH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356380489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3620 SHERIDAN DR
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14226-1631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-876-5512
Provider Business Mailing Address Fax Number:
716-876-7342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4041 DELAWARE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TONAWANDA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-876-5512
Provider Business Practice Location Address Fax Number:
716-876-7342
Provider Enumeration Date:
06/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  205688 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000524718001 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 156780CK . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0086173 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01843407 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0709060 . This is a "IHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4055 . This is a "UNIVERA PIN#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00010305501 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160035186 . This is a "RAILROAD BLOCK 24K" identifier . This identifiers is of the category "OTHER".




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