Provider Demographics
NPI:1104951524
Name:ALLEN, JOSEPHINE (PNP)
Entity type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 7TH AVE
Mailing Address - Street 2:ROOM 261
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6126
Mailing Address - Country:US
Mailing Address - Phone:718-788-6572
Mailing Address - Fax:718-788-6624
Practice Address - Street 1:511 7TH AVE
Practice Address - Street 2:ROOM 261
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6126
Practice Address - Country:US
Practice Address - Phone:718-788-6572
Practice Address - Fax:718-788-6624
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380808363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics