Provider Demographics
NPI:1811219447
Name:ALLERGY AND ASTHMA CENTER OF NORTHERN NEW JERSEY LLC
Entity Type:Organization
Organization Name:ALLERGY AND ASTHMA CENTER OF NORTHERN NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:I
Authorized Official - Last Name:MINIKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-564-7777
Mailing Address - Street 1:500 PIERMONT RD STE 304
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2846
Mailing Address - Country:US
Mailing Address - Phone:201-564-7777
Mailing Address - Fax:201-564-7776
Practice Address - Street 1:500 PIERMONT RD STE 304
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-2846
Practice Address - Country:US
Practice Address - Phone:201-564-7777
Practice Address - Fax:201-564-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA42598174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty