Provider Demographics
NPI:1801434709
Name:AVALON ALLERGY AND ASTHMA
Entity type:Organization
Organization Name:AVALON ALLERGY AND ASTHMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/SOLO PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARZAD
Authorized Official - Middle Name:JASMIN
Authorized Official - Last Name:ALAGHEBAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-656-5555
Mailing Address - Street 1:25 GLEN COVE AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2805
Mailing Address - Country:US
Mailing Address - Phone:516-656-5555
Mailing Address - Fax:
Practice Address - Street 1:25 GLEN COVE AVE
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2805
Practice Address - Country:US
Practice Address - Phone:516-656-5555
Practice Address - Fax:516-656-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty