Healthcare Provider Details

I. General information

NPI: 1811219447
Provider Name (Legal Business Name): ALLERGY AND ASTHMA CENTER OF NORTHERN NEW JERSEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PIERMONT RD STE 304
CLOSTER NJ
07624-2846
US

IV. Provider business mailing address

500 PIERMONT RD STE 304
CLOSTER NJ
07624-2846
US

V. Phone/Fax

Practice location:
  • Phone: 201-564-7777
  • Fax: 201-564-7776
Mailing address:
  • Phone: 201-564-7777
  • Fax: 201-564-7776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA42598
License Number StateNJ

VIII. Authorized Official

Name: DR. NEIL I MINIKES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-564-7777