Provider Demographics
NPI:1386099935
Name:ALLEN, MICHELE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 NEW YORK AVE
Mailing Address - Street 2:4M
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4275
Mailing Address - Country:US
Mailing Address - Phone:917-653-3106
Mailing Address - Fax:
Practice Address - Street 1:501 NEW YORK AVE
Practice Address - Street 2:4M
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-4275
Practice Address - Country:US
Practice Address - Phone:917-653-3106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist