Provider Demographics
NPI:1255618203
Name:ALLERGY CARE PLLC
Entity type:Organization
Organization Name:ALLERGY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LUDWIG
Authorized Official - Middle Name:E
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-624-7911
Mailing Address - Street 1:2206 GENESEE ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5829
Mailing Address - Country:US
Mailing Address - Phone:315-624-7911
Mailing Address - Fax:315-624-7912
Practice Address - Street 1:2206 GENESEE ST
Practice Address - Street 2:SUITE 303
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5829
Practice Address - Country:US
Practice Address - Phone:315-624-7911
Practice Address - Fax:315-624-7912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241599207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY241599-1OtherSTATE LICENSE NUMBER
NY02893667Medicaid
NYRB3688Medicare PIN
NY02893667Medicaid