1366763930 NPI number — ALLERGY AND IMMUNOLOGY CENTER PA

Table of content: (NPI 1366763930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366763930 NPI number — ALLERGY AND IMMUNOLOGY CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLERGY AND IMMUNOLOGY CENTER PA
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:
1366763930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8740 N KENDALL DR
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33176-2212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-270-1073
Provider Business Mailing Address Fax Number:
866-982-8070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8740 N KENDALL DR
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-270-1073
Provider Business Practice Location Address Fax Number:
866-982-8070
Provider Enumeration Date:
06/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CHAHINE
Authorized Official First Name:
BASSEM
Authorized Official Middle Name:
GEORGE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-270-1073

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  ME98543 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PENDING , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: D0508A . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 007101200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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