Basic Information
| Provider Information | |||||||||
| NPI: | 1093734022 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PULMONARY AND SLEEP ASSOCIATES OF SOUTH JERSEY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 BERLIN RD | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080343526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564291800 | ||||||||
| FaxNumber: | 8564291081 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 BERLIN RD | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080343526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564291800 | ||||||||
| FaxNumber: | 8564291081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 05/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | MAZZETTI | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8564291800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 7351101 | 05 | NJ | MEDICAID |