Healthcare Provider Details

I. General information

NPI: 1649784869
Provider Name (Legal Business Name): NJ ALLERGY MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 EAGLE ROCK AVE STE G3
WEST ORANGE NJ
07052-2994
US

IV. Provider business mailing address

48 CHESTNUT ST
LIVINGSTON NJ
07039-5502
US

V. Phone/Fax

Practice location:
  • Phone: 973-424-1300
  • Fax: 973-424-1722
Mailing address:
  • Phone: 908-295-7488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: SATYA D NARISETY
Title or Position: PRESIDENT
Credential:
Phone: 973-424-1300