Healthcare Provider Details

I. General information

NPI: 1790080919
Provider Name (Legal Business Name): COMPREHENSIVE ALLERGY AND ASTHMA CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 S BROADWAY 2ND FLOOR
TARRYTOWN NY
10591-4000
US

IV. Provider business mailing address

55 S BROADWAY 2ND FLOOR
TARRYTOWN NY
10591-4000
US

V. Phone/Fax

Practice location:
  • Phone: 914-631-3283
  • Fax: 914-631-3284
Mailing address:
  • Phone: 914-631-3283
  • Fax: 914-631-3284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number219055
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number219055
License Number StateNY

VIII. Authorized Official

Name: DR. ANNE MAITLAND
Title or Position: PHYSICIAN
Credential:
Phone: 914-631-3283