Provider Demographics
NPI:1508841503
Name:MANCHESTER ALLERGY, INC.
Entity Type:Organization
Organization Name:MANCHESTER ALLERGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NADER
Authorized Official - Last Name:KALLIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-668-6444
Mailing Address - Street 1:765 S MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-5141
Mailing Address - Country:US
Mailing Address - Phone:603-668-6444
Mailing Address - Fax:
Practice Address - Street 1:765 S MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5141
Practice Address - Country:US
Practice Address - Phone:603-668-6444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7573174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010246Medicaid
NH30010246Medicaid