Healthcare Provider Details

I. General information

NPI: 1679668917
Provider Name (Legal Business Name): MONTGOMERY ALLERGY ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 OLD YORK RD SUITE 801
JENKINTOWN PA
19046-3706
US

IV. Provider business mailing address

261 OLD YORK RD SUITE 801
JENKINTOWN PA
19046-3706
US

V. Phone/Fax

Practice location:
  • Phone: 215-884-7400
  • Fax: 215-884-7426
Mailing address:
  • Phone: 215-884-7400
  • Fax: 215-884-7426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD028559L
License Number StatePA

VIII. Authorized Official

Name: CHARLES G BLUMSTEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 215-884-7400