Healthcare Provider Details

I. General information

NPI: 1467007609
Provider Name (Legal Business Name): BOSTON FOOD ALLERGY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 BELFORT ST
PORTLAND ME
04103-1258
US

IV. Provider business mailing address

1 NASSAU STREET UNIT 1906
BOSTON MA
02111-1587
US

V. Phone/Fax

Practice location:
  • Phone: 207-807-4308
  • Fax:
Mailing address:
  • Phone: 178-046-7676
  • Fax: 877-726-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN LEUNG
Title or Position: OWNER
Credential: M.D
Phone: 617-804-6767