Provider Demographics
NPI:1104924901
Name:PROFESSIONAL ALLERGY ASSOC
Entity type:Organization
Organization Name:PROFESSIONAL ALLERGY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-366-4811
Mailing Address - Street 1:154 EAST MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WESTBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01581
Mailing Address - Country:US
Mailing Address - Phone:508-366-4811
Mailing Address - Fax:508-366-1216
Practice Address - Street 1:154 EAST MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:WESTBORO
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-366-4811
Practice Address - Fax:508-366-1216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA29219207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9771484Medicaid
MAM15845OtherBCBS GR#
MA=========OtherMISC. HMO'S
MA9771484Medicaid
MA=========OtherMISC. HMO'S