Provider Demographics
NPI:1740216969
Name:ALLERGY ALLIANCE GROUP LLC
Entity Type:Organization
Organization Name:ALLERGY ALLIANCE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:JAQUELINE
Authorized Official - Last Name:COLENDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-224-2256
Mailing Address - Street 1:811 ABBOTT BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4101
Mailing Address - Country:US
Mailing Address - Phone:201-224-2256
Mailing Address - Fax:201-224-5577
Practice Address - Street 1:811 ABBOTT BLVD
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4101
Practice Address - Country:US
Practice Address - Phone:201-224-2256
Practice Address - Fax:201-224-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03161600207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC55189Medicare UPIN
NJ095235Medicare ID - Type Unspecified