Individual
RICHARD ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 DATES DR, ITHACA, NY 14850-1342
(607) 274-4011
Mailing address
43 FOREST ACRES DR, ITHACA, NY 14850-9782
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
196066
NY
207P00000X
Emergency Medicine Physician
196066-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01498177
—
NY
01
—
196066-1
STATE LICENSE
NY
01
—
930836
ABEM
—
Enumeration date
09/20/2006
Last updated
03/07/2023
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