Provider Demographics
NPI:1174594055
Name:KAISER, ALLAN BRUCE (DO)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:BRUCE
Last Name:KAISER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GREENWOOD AVE.
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218
Mailing Address - Country:US
Mailing Address - Phone:718-871-9191
Mailing Address - Fax:718-438-6006
Practice Address - Street 1:800 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1340
Practice Address - Country:US
Practice Address - Phone:718-871-9191
Practice Address - Fax:718-438-6006
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106047207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB80580Medicare UPIN
NY507951Medicare PIN