Provider Demographics
NPI:1811103104
Name:FAMILY ALLERGY AND ASTHMA CARE, PLLC
Entity type:Organization
Organization Name:FAMILY ALLERGY AND ASTHMA CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:DAIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-751-4661
Mailing Address - Street 1:3771 NESCONSET HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1163
Mailing Address - Country:US
Mailing Address - Phone:631-751-4661
Mailing Address - Fax:631-689-2148
Practice Address - Street 1:3771 NESCONSET HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1163
Practice Address - Country:US
Practice Address - Phone:631-751-4661
Practice Address - Fax:631-689-2148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214548207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID NUMBER
NY=========OtherTAX ID NUMBER