Provider Demographics
NPI:1952361503
Name:SOUTH SHORE ALLERGY & ASTHMA SPECIALISTS P.C.
Entity Type:Organization
Organization Name:SOUTH SHORE ALLERGY & ASTHMA SPECIALISTS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-331-1060
Mailing Address - Street 1:851 MAIN ST
Mailing Address - Street 2:SUITE 21
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1612
Mailing Address - Country:US
Mailing Address - Phone:781-331-1060
Mailing Address - Fax:781-335-9852
Practice Address - Street 1:851 MAIN ST
Practice Address - Street 2:SUITE 21
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1612
Practice Address - Country:US
Practice Address - Phone:781-331-1060
Practice Address - Fax:781-335-9852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44319174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM13596OtherGROUP