Healthcare Provider Details

I. General information

NPI: 1801524897
Provider Name (Legal Business Name): ALLERGY AND ASTHMA CENTER OF EXCELLENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MEADE ST STE 211
DUNMORE PA
18512-3195
US

IV. Provider business mailing address

1000 MEADE ST STE 211
DUNMORE PA
18512-3195
US

V. Phone/Fax

Practice location:
  • Phone: 570-215-8001
  • Fax: 949-757-3831
Mailing address:
  • Phone: 570-215-8001
  • Fax: 949-757-3831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOEL J LAURY
Title or Position: PROVIDER
Credential: MD
Phone: 570-215-8001