Provider Demographics
NPI:1770770588
Name:NEW YORK ALLERGY AND ASTHMA PLLC
Entity type:Organization
Organization Name:NEW YORK ALLERGY AND ASTHMA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELF
Authorized Official - Prefix:MR
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIGHVANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-517-3300
Mailing Address - Street 1:PO BOX 20755
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0075
Mailing Address - Country:US
Mailing Address - Phone:212-517-3300
Mailing Address - Fax:212-517-3303
Practice Address - Street 1:261 E 78TH ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1216
Practice Address - Country:US
Practice Address - Phone:212-517-3300
Practice Address - Fax:212-517-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2015-10-06
Deactivation Date:2008-06-06
Deactivation Code:
Reactivation Date:2008-10-01
Provider Licenses
StateLicense IDTaxonomies
NY230079174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY208AB1Medicare PIN