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General NPI Number Information
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NPI Number | 1760701783
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Entity Type | Organization
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Legal Business Name | ADVANCED ASTHMA AND ALLERGY OF NNY, PLLC
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 05/04/2015
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Provider Practice Location Address
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Address Line | 19316 US ROUTE 11 BUILDING IV, SUITE C
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City | WATERTOWN
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State | NY
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Zip | 13601-5337
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Country | US
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Telephone | 315-681-4192
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Fax |
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Provider Business Mailing Address
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Address Line | 19316 US ROUTE 11 BUILDING IV, SUITE C
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City | WATERTOWN
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State | NY
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Zip | 13601-5337
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Country | US
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Telephone | 315-681-4192
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | DARIUSZ CHROSTOWSKI
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Credential | M.D.
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Telephone | 315-681-4192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 237708
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License Number State | NY
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