Provider Demographics
NPI:1104046838
Name:ALLERGY & ASTHMA OF SOUTH JERSEY
Entity type:Organization
Organization Name:ALLERGY & ASTHMA OF SOUTH JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:COIFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-825-4100
Mailing Address - Street 1:1122 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-2529
Mailing Address - Country:US
Mailing Address - Phone:856-825-4100
Mailing Address - Fax:
Practice Address - Street 1:1122 N HIGH ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-2529
Practice Address - Country:US
Practice Address - Phone:856-825-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA43090207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ051560Medicare ID - Type Unspecified
NJE56972Medicare UPIN