Provider Demographics
NPI:1821151572
Name:BACK BAY ALLERGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:BACK BAY ALLERGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:OSTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-734-2202
Mailing Address - Street 1:1101 BEACON ST
Mailing Address - Street 2:SUITE 7 EAST
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5587
Mailing Address - Country:US
Mailing Address - Phone:617-734-2202
Mailing Address - Fax:617-734-2408
Practice Address - Street 1:1101 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5587
Practice Address - Country:US
Practice Address - Phone:617-734-2202
Practice Address - Fax:617-734-2408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-17
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30946174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty