Individual
MR. JOHNATHAN ALBERT ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
130 W KINGSBRIDGE RD, BRONX, NY 10468-3904
(718) 741-4000
Mailing address
15764 SW 141ST ST, MIAMI, FL 33196-6717
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
026415
NY
Other
Enumeration date
01/24/2021
Last updated
09/15/2021
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