1326198961 NPI number — ALLERGY & ASTHMA CONSULTANTS PC

Table of content: (NPI 1326198961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326198961 NPI number — ALLERGY & ASTHMA CONSULTANTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLERGY & ASTHMA CONSULTANTS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326198961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4104 VESTAL RD
Provider Second Line Business Mailing Address:
STE 108
Provider Business Mailing Address City Name:
VESTAL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13850-3554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-729-0726
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4104 VESTAL RD
Provider Second Line Business Practice Location Address:
STE 108
Provider Business Practice Location Address City Name:
VESTAL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13850-3554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-729-0726
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DHILLON
Authorized Official First Name:
MOHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
607-729-0726

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  186177 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03802 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MD2000033 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 28365 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01274928 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 954180 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10032322 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4217085 . This is a "AETNA NON HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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