Provider Demographics
NPI:1316979974
Name:ALLERGY GROUP PC
Entity type:Organization
Organization Name:ALLERGY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEETU
Authorized Official - Middle Name:
Authorized Official - Last Name:TALREJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-377-4000
Mailing Address - Street 1:1000 N CURTIS RD
Mailing Address - Street 2:STE 303
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706
Mailing Address - Country:US
Mailing Address - Phone:208-377-4000
Mailing Address - Fax:208-375-8426
Practice Address - Street 1:1000 N CURTIS RD
Practice Address - Street 2:STE 303
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-377-4000
Practice Address - Fax:208-375-8426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1377787Medicare ID - Type UnspecifiedGROUP#