Provider Demographics
NPI:1003921990
Name:ALLERGY AFFILIATES, INC.
Entity Type:Organization
Organization Name:ALLERGY AFFILIATES, INC.
Other - Org Name:ELAINE F. WATERS, MD PA DBA ALLERGY AFFILIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-792-4151
Mailing Address - Street 1:5701 21ST AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5605
Mailing Address - Country:US
Mailing Address - Phone:941-792-4151
Mailing Address - Fax:941-792-8463
Practice Address - Street 1:5701 21ST AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5605
Practice Address - Country:US
Practice Address - Phone:941-792-4151
Practice Address - Fax:941-792-8463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21496Medicare PIN