Provider Demographics
NPI:1740364397
Name:ALLENDORF, JOHN DENNIS (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DENNIS
Last Name:ALLENDORF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:120 MINEOLA BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4064
Mailing Address - Country:US
Mailing Address - Phone:516-663-3300
Mailing Address - Fax:516-663-2136
Practice Address - Street 1:120 MINEOLA BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4064
Practice Address - Country:US
Practice Address - Phone:516-663-3300
Practice Address - Fax:516-663-2136
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2021-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY212487208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02288659Medicaid
NYH76123Medicare UPIN
NY0537H1Medicare ID - Type Unspecified