1942699749 NPI number — C.J. ALLEN OT UPPER EXTREMITY & HAND THERAPY, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942699749 NPI number — C.J. ALLEN OT UPPER EXTREMITY & HAND THERAPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C.J. ALLEN OT UPPER EXTREMITY & HAND THERAPY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1942699749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 AMBER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAUPPAUGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11788-3107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-761-6996
Provider Business Mailing Address Fax Number:
631-761-6997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2108 JOSHUAS PATH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAUPPAUGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11788-4764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-761-6996
Provider Business Practice Location Address Fax Number:
631-761-6997
Provider Enumeration Date:
01/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
JACK
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
516-779-6798

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X , with the licence number: 011083 , 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)





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