Healthcare Provider Details

I. General information

NPI: 1003937988
Provider Name (Legal Business Name): ALLERGY ASSOCIATES OF HARTFORD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 HEBRON AVE STE 104B
GLASTONBURY CT
06033-5003
US

IV. Provider business mailing address

622 HEBRON AVE STE 104B
GLASTONBURY CT
06033-5003
US

V. Phone/Fax

Practice location:
  • Phone: 860-659-8904
  • Fax: 860-246-5828
Mailing address:
  • Phone: 860-659-8904
  • Fax: 860-246-5828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number000644
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number003860
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number022206
License Number StateCT

VIII. Authorized Official

Name: PRASAD SRINIVASAN
Title or Position: PRESIDENT
Credential:
Phone: 860-246-7273