Provider Demographics
NPI:1386732964
Name:BURTON ALLYN M.D.,P.C.
Entity type:Organization
Organization Name:BURTON ALLYN M.D.,P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER - PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BURTON
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLYN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-561-1100
Mailing Address - Street 1:833 BLOOMING GROVE TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-8102
Mailing Address - Country:US
Mailing Address - Phone:845-561-1100
Mailing Address - Fax:845-561-0414
Practice Address - Street 1:833 BLOOMING GROVE TPKE
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-8102
Practice Address - Country:US
Practice Address - Phone:845-561-1100
Practice Address - Fax:845-561-0414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081303207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW1L682Medicare ID - Type UnspecifiedMEDICARE ORGANIZATION ID
NY155742Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID
NYC06064Medicare UPIN