Provider Demographics
NPI:1073990701
Name:ALLEGIANCE HEALTH GROUP LLC
Entity Type:Organization
Organization Name:ALLEGIANCE HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-815-7773
Mailing Address - Street 1:40 FULD ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-5247
Mailing Address - Country:US
Mailing Address - Phone:609-815-7773
Mailing Address - Fax:609-394-6328
Practice Address - Street 1:1719 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4665
Practice Address - Country:US
Practice Address - Phone:609-337-7925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory