Provider Demographics
NPI:1861467409
Name:ALLERGY & ASTHMA CLINIC INC.
Entity type:Organization
Organization Name:ALLERGY & ASTHMA CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARESH
Authorized Official - Middle Name:I
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-226-1599
Mailing Address - Street 1:1008 S 5TH AVE
Mailing Address - Street 2:CRICKLEWOOD CENTER STE. 201
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8676
Mailing Address - Country:US
Mailing Address - Phone:814-226-1599
Mailing Address - Fax:814-226-1583
Practice Address - Street 1:1008 S 5TH AVE
Practice Address - Street 2:CRICKLEWOOD CENTER STE. 201
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8676
Practice Address - Country:US
Practice Address - Phone:814-226-1599
Practice Address - Fax:814-226-1583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056503L208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007764110001Medicaid
1507399OtherGATEWAY
1507399OtherGATEWAY