1255618203 NPI number — ALLERGY CARE PLLC

Table of content: (NPI 1255618203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255618203 NPI number — ALLERGY CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLERGY CARE PLLC
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:
1255618203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2206 GENESEE ST
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
UTICA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13502-5829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-624-7911
Provider Business Mailing Address Fax Number:
315-624-7912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2206 GENESEE ST
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
UTICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13502-5829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-624-7911
Provider Business Practice Location Address Fax Number:
315-624-7912
Provider Enumeration Date:
11/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KHOURY
Authorized Official First Name:
LUDWIG
Authorized Official Middle Name:
E
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
315-624-7911

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  241599 , 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: 241599-1 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02893667 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com