1780047621 NPI number — ADVANCED ALLERGY ASSOCIATES OF NEW MEXICO INC

Table of content: DR. PETER CHRISTOPHER WENGER M.D, (NPI 1396066627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780047621 NPI number — ADVANCED ALLERGY ASSOCIATES OF NEW MEXICO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED ALLERGY ASSOCIATES OF NEW MEXICO INC
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:
1780047621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5310 HOMESTEAD RD NE STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87110-1524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-237-2574
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5310 HOMESTEAD RD NE STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110-1524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-237-2574
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WESSELS
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT OF OPERATIONS
Authorized Official Telephone Number:
505-237-2574

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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