Provider Demographics
NPI:1164013140
Name:KEYSTONE ALLERGY AND ASTHMA CENTER PC
Entity Type:Organization
Organization Name:KEYSTONE ALLERGY AND ASTHMA CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SUJAL
Authorized Official - Middle Name:P
Authorized Official - Last Name:GHELANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:484-897-7143
Mailing Address - Street 1:310 EXTON CMNS
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2450
Mailing Address - Country:US
Mailing Address - Phone:484-897-7143
Mailing Address - Fax:484-328-6491
Practice Address - Street 1:310 EXTON COMMONS
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341
Practice Address - Country:US
Practice Address - Phone:610-890-9990
Practice Address - Fax:610-890-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2024-03-27
Deactivation Date:2021-08-18
Deactivation Code:
Reactivation Date:2023-07-31
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/ImmunologyGroup - Single Specialty