Basic Information
| Provider Information | |||||||||
| NPI: | 1326006750 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | HERBERT | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 WHITE HORSE PIKE | ||||||||
| Address2: | |||||||||
| City: | HADDON HGTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080351908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565465353 | ||||||||
| FaxNumber: | 8565465315 | ||||||||
| Practice Location | |||||||||
| Address1: | 219 N BROAD ST | ||||||||
| Address2: | 4TH FL | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191071519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157625550 | ||||||||
| FaxNumber: | 2157625570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0900X | 25MA02930300 | NJ | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology |
ID Information
| ID | Type | State | Issuer | Description | 001910299 | 05 | PA | MEDICAID |