Provider Demographics
NPI:1780607184
Name:ALLERGY AND ASTHMA MEDICAL PC
Entity type:Organization
Organization Name:ALLERGY AND ASTHMA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-938-1502
Mailing Address - Street 1:200 CHAMBERS ST
Mailing Address - Street 2:#27B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-1082
Mailing Address - Country:US
Mailing Address - Phone:212-505-9006
Mailing Address - Fax:508-590-0240
Practice Address - Street 1:200 W 57TH ST
Practice Address - Street 2:15TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3211
Practice Address - Country:US
Practice Address - Phone:212-247-2080
Practice Address - Fax:508-590-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228065207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEZ121Medicare ID - Type UnspecifiedGROUP #
NYY48505Medicare UPIN