Advanced Allergy Immunology & Asthma PC

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

029667 Issued in CT

Legal business name

ADVANCED ALLERGY IMMUNOLOGY & ASTHMA PC

Practice address

125 Strawberry Hill Ave
Stanford, CT 06902

Phone

(203) 202-7799

Fax

(203) 656-1416

NPI assigned

Sep 4, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Denis A Bouboulis, M.D

Title

Medical Doctor/Owner

Phone

(203) 202-7799

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christopher Gennino, D.O.

  • Family Medicine Physician
  • Milford, CT
  • NPI 1649385758

  CT

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358121600000",
    "number": "1780933937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 NOROTON AVE",
            "city": "DARIEN",
            "state": "CT",
            "postal_code": "068205237",
            "telephone_number": "203-202-7799",
            "fax_number": "203-656-1416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 STRAWBERRY HILL AVE",
            "city": "STANFORD",
            "state": "CT",
            "postal_code": "06902",
            "telephone_number": "203-202-7799",
            "fax_number": "203-656-1416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED ALLERGY IMMUNOLOGY & ASTHMA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-04",
        "last_updated": "2013-01-14",
        "status": "A",
        "authorized_official_last_name": "BOUBOULIS",
        "authorized_official_first_name": "DENIS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEDICAL DOCTOR/OWNER",
        "authorized_official_telephone_number": "203-202-7799",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology",
            "state": "CT",
            "license": "029667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eluisa Brunetto, MSW
• Carolyn Falconer-Horne, M.S.
• Greenwich Hospital

• All providers in Stanford, CT
• Allergy & Immunology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.