Provider Demographics
NPI:1003945965
Name:PROFESSIONAL ALLERGY ASSOCIATES P.A.
Entity Type:Organization
Organization Name:PROFESSIONAL ALLERGY ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:ROMANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-429-4922
Mailing Address - Street 1:1034 MARLTON PIKE E
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2400
Mailing Address - Country:US
Mailing Address - Phone:856-429-4922
Mailing Address - Fax:856-429-7780
Practice Address - Street 1:1034 MARLTON PIKE E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2400
Practice Address - Country:US
Practice Address - Phone:856-429-4922
Practice Address - Fax:856-429-7780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA25049207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1161601Medicaid
NJ0000129396Medicare ID - Type Unspecified
NJC-58866Medicare UPIN