Provider Demographics
NPI:1366763930
Name:ALLERGY AND IMMUNOLOGY CENTER PA
Entity type:Organization
Organization Name:ALLERGY AND IMMUNOLOGY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BASSEM
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:CHAHINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-270-1073
Mailing Address - Street 1:8740 N KENDALL DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2212
Mailing Address - Country:US
Mailing Address - Phone:305-270-1073
Mailing Address - Fax:866-982-8070
Practice Address - Street 1:8740 N KENDALL DR
Practice Address - Street 2:SUITE 215
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2212
Practice Address - Country:US
Practice Address - Phone:305-270-1073
Practice Address - Fax:866-982-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98543207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
FLD0508AOtherMEDICARE PTAN