Provider Demographics
NPI:1235403163
Name:ALLERGY & ASTHMA OF THE SOUTH SHORE PC
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA OF THE SOUTH SHORE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-341-7076
Mailing Address - Street 1:949 CENTRAL AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1204
Mailing Address - Country:US
Mailing Address - Phone:516-341-7076
Mailing Address - Fax:516-341-7077
Practice Address - Street 1:949 CENTRAL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1204
Practice Address - Country:US
Practice Address - Phone:516-341-7076
Practice Address - Fax:516-341-7077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242900207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty