Provider Demographics
NPI:1447597315
Name:NEW ENGLAND FOOD ALLERGY TREATMENT CENTER
Entity Type:Organization
Organization Name:NEW ENGLAND FOOD ALLERGY TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:FACTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-916-0273
Mailing Address - Street 1:836 FARMINGTON AVE
Mailing Address - Street 2:SUITE 138
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1505
Mailing Address - Country:US
Mailing Address - Phone:860-986-6099
Mailing Address - Fax:860-761-2674
Practice Address - Street 1:836 FARMINGTON AVE
Practice Address - Street 2:SUITE 138
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1505
Practice Address - Country:US
Practice Address - Phone:860-986-6099
Practice Address - Fax:860-761-2674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031434207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty