Healthcare Provider Details

I. General information

NPI: 1104924901
Provider Name (Legal Business Name): PROFESSIONAL ALLERGY ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 EAST MAIN ST SUITE 203
WESTBORO MA
01581
US

IV. Provider business mailing address

154 EAST MAIN ST SUITE 203
WESTBORO MA
01581
US

V. Phone/Fax

Practice location:
  • Phone: 508-366-4811
  • Fax: 508-366-1216
Mailing address:
  • Phone: 508-366-4811
  • Fax: 508-366-1216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number29219
License Number StateMA

VIII. Authorized Official

Name: STANLEY R SAKOWITZ
Title or Position: PHYSICIAN PRESIDENT
Credential: MD
Phone: 508-366-4811