Basic Information
| Provider Information | |||||||||
| NPI: | 1144290016 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLERGY & ASTHMA SPECIALISTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 470 SENTRY PKWY E | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BLUE BELL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194222324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108255800 | ||||||||
| FaxNumber: | 6103970980 | ||||||||
| Practice Location | |||||||||
| Address1: | 470 SENTRY PKWY E | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BLUE BELL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194222324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108255800 | ||||||||
| FaxNumber: | 6103970980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 11/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | ANOLIK | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6108255800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 7256148 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 1461100 | 05 | PA | MEDICAID |