Provider Demographics
NPI:1225784044
Name:VALLEN ALLERGY AND ASTHMA, PC
Entity Type:Organization
Organization Name:VALLEN ALLERGY AND ASTHMA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-404-1750
Mailing Address - Street 1:700 CONGRESS ST STE 301
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0977
Mailing Address - Country:US
Mailing Address - Phone:617-472-7111
Mailing Address - Fax:
Practice Address - Street 1:700 CONGRESS ST STE 301
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0977
Practice Address - Country:US
Practice Address - Phone:617-472-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty