Provider Demographics
NPI:1639433410
Name:ALLERGY AND ASTHMA COMPREHENSIVE CARE
Entity type:Organization
Organization Name:ALLERGY AND ASTHMA COMPREHENSIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-906-6247
Mailing Address - Street 1:541 CEDAR HILL AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2150
Mailing Address - Country:US
Mailing Address - Phone:201-652-6211
Mailing Address - Fax:201-652-0321
Practice Address - Street 1:541 CEDAR HILL AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2150
Practice Address - Country:US
Practice Address - Phone:201-652-6211
Practice Address - Fax:201-652-0321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07980000207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ097607T4FMedicare PIN
NJH70212Medicare UPIN