Provider Demographics
NPI:1649991043
Name:NEW ENGLAND ALLERGY,ASTHMA,IMMUNOLOGY,PEDIATRIC AND PRIMARY CARE, PLLC
Entity type:Organization
Organization Name:NEW ENGLAND ALLERGY,ASTHMA,IMMUNOLOGY,PEDIATRIC AND PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-683-4299
Mailing Address - Street 1:555 TURNPIKE ST STE 31
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5935
Mailing Address - Country:US
Mailing Address - Phone:978-683-4299
Mailing Address - Fax:978-688-9603
Practice Address - Street 1:555 TURNPIKE ST STE 31
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5935
Practice Address - Country:US
Practice Address - Phone:978-683-4299
Practice Address - Fax:978-688-9603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty