MEDICARE: ALLERGY AND ASTHMA SPECIALTY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	25MA07757400	NJ

General Provider Information

NPI Number	:	1548271075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLERGY AND ASTHMA SPECIALTY CARE LLC

Provider Business Mailing Address
First Line	:	9 WOODBINE RD
Second Line	:
City	:	FLORHAM PARK
State	:	NJ
Zip	:	07932-2649
Country	:	US
Telephone Number	:	973-377-4122
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 W MAIN ST
Second Line	:	SUITE 103
City	:	DENVILLE
State	:	NJ
Zip	:	07834-2174
Country	:	US
Telephone Number	:	973-902-4393
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. SMRUTI A. PARIKH
Credential	:	M.D.
Telephone Number	:	973-902-4393

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	08/22/2020

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