Provider Demographics
NPI:1720523079
Name:OCEAN STATE ASTHMA AND ALLERGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:OCEAN STATE ASTHMA AND ALLERGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-753-0500
Mailing Address - Street 1:1637 MINERAL SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4042
Mailing Address - Country:US
Mailing Address - Phone:401-353-1012
Mailing Address - Fax:401-353-6362
Practice Address - Street 1:63 CEDAR AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3191
Practice Address - Country:US
Practice Address - Phone:401-885-5757
Practice Address - Fax:401-885-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty