Provider Demographics
NPI:1720366453
Name:ADVANCED ALLERGY & ASTHMA FAMILY CARE PLLC
Entity Type:Organization
Organization Name:ADVANCED ALLERGY & ASTHMA FAMILY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NEHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADHOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-261-9786
Mailing Address - Street 1:11 RALPH PL STE 205
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4405
Mailing Address - Country:US
Mailing Address - Phone:718-273-9111
Mailing Address - Fax:718-448-2003
Practice Address - Street 1:11 RALPH PL
Practice Address - Street 2:SUITE 305
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4401
Practice Address - Country:US
Practice Address - Phone:718-273-9111
Practice Address - Fax:718-448-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249365207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty