Provider Demographics
NPI:1447456090
Name:ALLERGY MEDICAL ASSOCIATES OF NORTH SHORE INC.
Entity type:Organization
Organization Name:ALLERGY MEDICAL ASSOCIATES OF NORTH SHORE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIRANJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-595-6800
Mailing Address - Street 1:214 OCEAN ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3150
Mailing Address - Country:US
Mailing Address - Phone:781-595-6800
Mailing Address - Fax:781-599-7060
Practice Address - Street 1:214 OCEAN ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-3150
Practice Address - Country:US
Practice Address - Phone:781-595-6800
Practice Address - Fax:781-599-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36270207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9783857Medicaid
4650694OtherAETNA
MA036270OtherTUFTS
MA3090310OtherNHP
646761OtherHARVARD PILGRIM
MA036270OtherTUFTS
MA9783857Medicaid