Provider Demographics
NPI:1083705891
Name:FAIRFIELD COUNTY ALLERGY ASTHMA & IMMUNOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:FAIRFIELD COUNTY ALLERGY ASTHMA & IMMUNOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHIRICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-869-2080
Mailing Address - Street 1:148 EAST AVENUE
Mailing Address - Street 2:SUITE 3G
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851
Mailing Address - Country:US
Mailing Address - Phone:203-838-4034
Mailing Address - Fax:203-853-6361
Practice Address - Street 1:148 EAST AVENUE
Practice Address - Street 2:SUITE 3G
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-838-4034
Practice Address - Fax:203-853-6361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00905Medicare PIN