Provider Demographics
NPI:1649474594
Name:ENGLEWOOD ALLERGY ASSOCIATES, LLC
Entity type:Organization
Organization Name:ENGLEWOOD ALLERGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:FROM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-568-1480
Mailing Address - Street 1:309 ENGLE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1824
Mailing Address - Country:US
Mailing Address - Phone:201-568-1480
Mailing Address - Fax:201-568-1326
Practice Address - Street 1:309 ENGLE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1824
Practice Address - Country:US
Practice Address - Phone:201-568-1480
Practice Address - Fax:201-568-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05783700207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF29465Medicare UPIN
NJFR724879Medicare ID - Type Unspecified