Provider Demographics
NPI:1376845453
Name:ADVANCED ALLERGY & ASTHMA ASSESSMENT & DIAGNOSTIC, P.C.
Entity Type:Organization
Organization Name:ADVANCED ALLERGY & ASTHMA ASSESSMENT & DIAGNOSTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-224-7600
Mailing Address - Street 1:202-28 45TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2540
Mailing Address - Country:US
Mailing Address - Phone:718-224-7600
Mailing Address - Fax:718-224-0593
Practice Address - Street 1:202-28 45TH AVENUE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2540
Practice Address - Country:US
Practice Address - Phone:718-224-7600
Practice Address - Fax:718-224-0593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187008207K00000X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01523308Medicaid
NY01336Medicare PIN
NYF77948Medicare UPIN
NY01523308Medicaid