Provider Demographics
NPI:1710033477
Name:ALLERGIC DISEASE ASSOCIATES PC
Entity Type:Organization
Organization Name:ALLERGIC DISEASE ASSOCIATES PC
Other - Org Name:THE ASTHMA CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:F
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-569-1111
Mailing Address - Street 1:205 N BROAD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1554
Mailing Address - Country:US
Mailing Address - Phone:215-569-1111
Mailing Address - Fax:215-569-8797
Practice Address - Street 1:205 N BROAD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1554
Practice Address - Country:US
Practice Address - Phone:215-569-1111
Practice Address - Fax:215-569-8797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA413636Medicare PIN
NJ896212Medicare PIN