Provider Demographics
NPI:1679612527
Name:ALLERGY AND IMMUNOLOGY ASSOCIATES OF TEANECK AND RIVER EDGE P A
Entity Type:Organization
Organization Name:ALLERGY AND IMMUNOLOGY ASSOCIATES OF TEANECK AND RIVER EDGE P A
Other - Org Name:TEANECK ALLERGY AND IMMUNOLOGY ASSOCIATES P A
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:FALK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-487-2900
Mailing Address - Street 1:63 GRAND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1930
Mailing Address - Country:US
Mailing Address - Phone:201-487-2900
Mailing Address - Fax:201-487-1022
Practice Address - Street 1:63 GRAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-1930
Practice Address - Country:US
Practice Address - Phone:201-487-2900
Practice Address - Fax:201-487-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40562207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty