Provider Demographics
NPI:1235353426
Name:ALLERGY CENTER OF CONNECTICUT, P.C.
Entity Type:Organization
Organization Name:ALLERGY CENTER OF CONNECTICUT, P.C.
Other - Org Name:ALLERGY ASSOCIATES OF FAIRFIELD COUNTY, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:203-374-6103
Mailing Address - Street 1:4675 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1813
Mailing Address - Country:US
Mailing Address - Phone:203-374-6104
Mailing Address - Fax:203-374-1663
Practice Address - Street 1:4675 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1813
Practice Address - Country:US
Practice Address - Phone:203-374-6104
Practice Address - Fax:203-374-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT50ALLASFFCT01OtherBLUE CROSS BLUE SHIELD
CT004164597Medicaid
CTG381235OtherOXFORD GROUP NUMBER
CT50ALLASFFCT01OtherBLUE CROSS BLUE SHIELD