Healthcare Provider Details

I. General information

NPI: 1508004714
Provider Name (Legal Business Name): ALLERGY AND ASTHMA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 TECHNOLOGY DR SUITE B 302
TRUMBULL CT
06611-6337
US

IV. Provider business mailing address

115 TECHNOLOGY DR SUITE B 302
TRUMBULL CT
06611-6337
US

V. Phone/Fax

Practice location:
  • Phone: 203-459-8712
  • Fax: 203-459-8739
Mailing address:
  • Phone: 203-459-8712
  • Fax: 203-459-8739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number030566
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number030566
License Number StateCT

VIII. Authorized Official

Name: DR. MICHAEL S KING
Title or Position: OWNER
Credential: MD
Phone: 203-459-8712