Provider Demographics
NPI:1699716274
Name:SMALL, ALLEN C (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:C
Last Name:SMALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4 IRVING PL
Mailing Address - Street 2:FL 11
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3502
Mailing Address - Country:US
Mailing Address - Phone:718-261-1000
Mailing Address - Fax:718-261-0336
Practice Address - Street 1:8046 KEW GARDENS RD
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1154
Practice Address - Country:US
Practice Address - Phone:718-261-1000
Practice Address - Fax:718-261-0336
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY145789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB78930Medicare UPIN
NY9255NCMedicare ID - Type Unspecified