Provider Demographics
NPI:1558468066
Name:SOUTH JERSEY ALLERGY AND ASTHMA ASSOC
Entity Type:Organization
Organization Name:SOUTH JERSEY ALLERGY AND ASTHMA ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAZIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-428-5120
Mailing Address - Street 1:108 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2504
Mailing Address - Country:US
Mailing Address - Phone:856-428-5120
Mailing Address - Fax:856-428-0264
Practice Address - Street 1:108 KINGS HWY S
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2504
Practice Address - Country:US
Practice Address - Phone:856-428-5120
Practice Address - Fax:856-428-0264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2666707Medicaid
135661Medicare ID - Type Unspecified