Healthcare Provider Details

I. General information

NPI: 1407919194
Provider Name (Legal Business Name): MAIN STREET ALLERGY & ASTHMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 E MAIN ST
MARLTON NJ
08053-2141
US

IV. Provider business mailing address

54 E MAIN ST
MARLTON NJ
08053-2141
US

V. Phone/Fax

Practice location:
  • Phone: 856-988-0570
  • Fax: 856-988-0303
Mailing address:
  • Phone: 856-988-0570
  • Fax: 856-988-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EUGENE A GATTI
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 856-988-0570