1639174949 NPI number — ALLEN LAURENCE CARL M.D.

Table of content: ALLEN LAURENCE CARL M.D. (NPI 1639174949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639174949 NPI number — ALLEN LAURENCE CARL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARL
Provider First Name:
ALLEN
Provider Middle Name:
LAURENCE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1639174949
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1367 WASHINGTON AVE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12206-1043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-489-2666
Provider Business Mailing Address Fax Number:
518-489-5933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1367 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12206-1043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-489-2666
Provider Business Practice Location Address Fax Number:
518-489-5933
Provider Enumeration Date:
06/15/2005

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: 207X00000X , with the licence number:  143645 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0117X , with the licence number: 143645-0 , 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: 000406266006 . This is a "BS NENY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 18314 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4591431 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 84G891 . This is a "EMPIRE BC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10006085 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00964094 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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