Basic Information
| Provider Information | |||||||||
| NPI: | 1386060432 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BREATHE EASY ALLERGY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | BREATHE EASY ALLERGY AND ASTHMA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1111 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE N 804 | ||||||||
| City: | MARRERO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700723151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049348777 | ||||||||
| FaxNumber: | 5049348778 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE N 804 | ||||||||
| City: | MARRERO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700723151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049348777 | ||||||||
| FaxNumber: | 5049348778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2014 | ||||||||
| LastUpdateDate: | 07/03/2014 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KAMBOJ | ||||||||
| AuthorizedOfficialFirstName: | SONIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 5049348777 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207K00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology |
No ID Information.