Healthcare Provider Details

I. General information

NPI: 1649991043
Provider Name (Legal Business Name): NEW ENGLAND ALLERGY,ASTHMA,IMMUNOLOGY,PEDIATRIC AND PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 TURNPIKE ST STE 31
NORTH ANDOVER MA
01845-5935
US

IV. Provider business mailing address

555 TURNPIKE ST STE 31
NORTH ANDOVER MA
01845-5935
US

V. Phone/Fax

Practice location:
  • Phone: 978-683-4299
  • Fax: 978-688-9603
Mailing address:
  • Phone: 978-683-4299
  • Fax: 978-688-9603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIFFANY K. JOHNSON
Title or Position: OWNDER/PHYSICIAN
Credential: M.D.
Phone: 978-683-4299