Provider Demographics
NPI:1669424065
Name:EAST END ALLERGY AND ASTHMA CARE, PC
Entity type:Organization
Organization Name:EAST END ALLERGY AND ASTHMA CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-591-2209
Mailing Address - Street 1:1149 OLD COUNTRY ROAD
Mailing Address - Street 2:SUITE E-1
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2063
Mailing Address - Country:US
Mailing Address - Phone:631-591-2209
Mailing Address - Fax:631-591-2194
Practice Address - Street 1:1149 OLD COUNTRY ROAD
Practice Address - Street 2:SUITE E-1
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2063
Practice Address - Country:US
Practice Address - Phone:631-591-2209
Practice Address - Fax:631-591-2194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211349207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG78132Medicare UPIN