Healthcare Provider Details

I. General information

NPI: 1639433410
Provider Name (Legal Business Name): ALLERGY AND ASTHMA COMPREHENSIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 CEDAR HILL AVE SUITE 8
WYCKOFF NJ
07481-2150
US

IV. Provider business mailing address

541 CEDAR HILL AVE SUITE 8
WYCKOFF NJ
07481-2150
US

V. Phone/Fax

Practice location:
  • Phone: 201-652-6211
  • Fax: 201-652-0321
Mailing address:
  • Phone: 201-652-6211
  • Fax: 201-652-0321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25MA07980000
License Number StateNJ

VIII. Authorized Official

Name: DR. ALEXANDER MAROTTA
Title or Position: OWNER
Credential: M.D.
Phone: 201-906-6247