Provider Demographics
NPI:1235176595
Name:ALLERGY ASSOCIATES OF NEW LONDON, PC
Entity Type:Organization
Organization Name:ALLERGY ASSOCIATES OF NEW LONDON, PC
Other - Org Name:ALLERGY ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPRECACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD JD
Authorized Official - Phone:860-443-0769
Mailing Address - Street 1:196 PARKWAY S
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-1234
Mailing Address - Country:US
Mailing Address - Phone:860-442-7027
Mailing Address - Fax:860-444-0074
Practice Address - Street 1:400 BAYONET ST
Practice Address - Street 2:SUITE LL2
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-2600
Practice Address - Country:US
Practice Address - Phone:860-443-0769
Practice Address - Fax:860-443-1278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT50ALASCNLCT01OtherANTHEM BLUE CROSS/BLUE SHIELD
CTC00255Medicare PIN