Provider Demographics
NPI:1831492644
Name:ALLERGY & CLINICAL IMMUNOLOGY CENTER
Entity Type:Organization
Organization Name:ALLERGY & CLINICAL IMMUNOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JIN
Authorized Official - Middle Name:PING
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-797-8886
Mailing Address - Street 1:6 DAFFODIL LN
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-4808
Mailing Address - Country:US
Mailing Address - Phone:856-797-8886
Mailing Address - Fax:856-985-2866
Practice Address - Street 1:230 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9400
Practice Address - Country:US
Practice Address - Phone:856-797-8886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA074632207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty