Provider Demographics
NPI:1891033288
Name:HACKENSACK ALLERGY & ASTHMA CENTER, LLC
Entity Type:Organization
Organization Name:HACKENSACK ALLERGY & ASTHMA CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:AQUINAS
Authorized Official - Last Name:SELVAGGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-343-6673
Mailing Address - Street 1:655 SOLDIER HILL RD
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1201
Mailing Address - Country:US
Mailing Address - Phone:201-343-6673
Mailing Address - Fax:201-343-7555
Practice Address - Street 1:211 ESSEX ST
Practice Address - Street 2:SUITE 401
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3231
Practice Address - Country:US
Practice Address - Phone:201-343-6673
Practice Address - Fax:201-343-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06521100207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Single Specialty