Provider Demographics
NPI:1992043483
Name:ALLERGY AND ASTHMA CONSULTANTS OF FAIRFIELD COUNTY, LLC
Entity Type:Organization
Organization Name:ALLERGY AND ASTHMA CONSULTANTS OF FAIRFIELD COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTSCHUL-LATZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-872-6795
Mailing Address - Street 1:140 SHERMAN ST FL 3
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5849
Mailing Address - Country:US
Mailing Address - Phone:203-955-1461
Mailing Address - Fax:203-955-1464
Practice Address - Street 1:140 SHERMAN ST FL 3
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5849
Practice Address - Country:US
Practice Address - Phone:203-955-1461
Practice Address - Fax:203-955-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1003855859OtherINDIVIDUAL NPI NUMBER