Provider Demographics
NPI:1083719157
Name:ALLERGY TREATMENT CENTER OF NEW JERSEY
Entity Type:Organization
Organization Name:ALLERGY TREATMENT CENTER OF NEW JERSEY
Other - Org Name:ATCNJ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUMNEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-283-3040
Mailing Address - Street 1:1100 CENTENNIAL AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4152
Mailing Address - Country:US
Mailing Address - Phone:732-562-1717
Mailing Address - Fax:732-562-1770
Practice Address - Street 1:1100 CENTENNIAL AVE STE 202
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-4152
Practice Address - Country:US
Practice Address - Phone:732-562-1717
Practice Address - Fax:732-562-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA069610174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ105342Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER