Provider Demographics
NPI:1578616579
Name:ALLERGY AND CLINICAL IMMUNOLOGY CENTER, P.A.
Entity Type:Organization
Organization Name:ALLERGY AND CLINICAL IMMUNOLOGY CENTER, P.A.
Other - Org Name:ALLERGY AND CLINICAL IMMUNOLOGY CENTER PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:USHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-377-4112
Mailing Address - Street 1:29 COLUMBIA TPKE STE 202
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2240
Mailing Address - Country:US
Mailing Address - Phone:973-377-4112
Mailing Address - Fax:973-377-2775
Practice Address - Street 1:29 COLUMBIA TPKE STE 202
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2240
Practice Address - Country:US
Practice Address - Phone:973-377-4112
Practice Address - Fax:973-377-2775
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:USHA SUNDARAM MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-21
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA028825207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty