Provider Demographics
NPI:1407841240
Name:BAY SHORE ALLERGY & ASTHMA SPECIALTY PRACTICE, P.C.
Entity type:Organization
Organization Name:BAY SHORE ALLERGY & ASTHMA SPECIALTY PRACTICE, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GUIDA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:631-665-2584
Mailing Address - Street 1:649 W MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8222
Mailing Address - Country:US
Mailing Address - Phone:631-665-2584
Mailing Address - Fax:631-665-0290
Practice Address - Street 1:649 W MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8222
Practice Address - Country:US
Practice Address - Phone:631-665-2584
Practice Address - Fax:631-665-0290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181187-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty