=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215968946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED ALLERGY AND ASTHMA FAMILY CARE,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 714 CHASE PKWY SUITE 2B
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06708-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-755-5500
-----------------------------------------------------
Fax | 203-755-0776
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 714 CHASE PKWY SUITE 2B
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06708-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-755-5500
-----------------------------------------------------
Fax | 203-755-0776
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. LARRY SCHEER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 203-755-5500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | 032579
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------