Provider Demographics
NPI:1861880957
Name:THE INSTITUTE OF ALLERGY,IMMUNOLOGY & ASTHMA FOR ADULTS AND CHILDREN P
Entity type:Organization
Organization Name:THE INSTITUTE OF ALLERGY,IMMUNOLOGY & ASTHMA FOR ADULTS AND CHILDREN P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-845-8300
Mailing Address - Street 1:630 SALEM AVENUE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096
Mailing Address - Country:US
Mailing Address - Phone:856-845-8300
Mailing Address - Fax:856-845-1225
Practice Address - Street 1:630 SALEM AVENUE
Practice Address - Street 2:WESTBURY PROFESSIONAL BUILDING
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096
Practice Address - Country:US
Practice Address - Phone:856-845-8300
Practice Address - Fax:856-845-1225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07893400207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty