Provider Demographics
NPI:1710523147
Name:BOSTON FOOD ALLERGY CENTER LLC BI NETWORK
Entity type:Organization
Organization Name:BOSTON FOOD ALLERGY CENTER LLC BI NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-804-6767
Mailing Address - Street 1:1 NASSAU ST UNIT 1906
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1587
Mailing Address - Country:US
Mailing Address - Phone:617-804-6767
Mailing Address - Fax:877-726-8492
Practice Address - Street 1:75 KNEELAND ST FL 1
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1901
Practice Address - Country:US
Practice Address - Phone:617-804-6767
Practice Address - Fax:977-726-8492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty