Provider Demographics
NPI:1619903358
Name:ADVANCED ALLERGY ASTHMA & SINUS CENTER, PA
Entity Type:Organization
Organization Name:ADVANCED ALLERGY ASTHMA & SINUS CENTER, PA
Other - Org Name:HAMILTON ALLERGY ASTHMA & SINUS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASLAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LATEEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-584-9200
Mailing Address - Street 1:2333 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1946
Mailing Address - Country:US
Mailing Address - Phone:609-584-9200
Mailing Address - Fax:609-584-9299
Practice Address - Street 1:2333 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE G
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1946
Practice Address - Country:US
Practice Address - Phone:609-584-9200
Practice Address - Fax:609-584-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07700100261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI13440Medicare UPIN
NJ103885Medicare PIN