Provider Demographics
NPI:1043343270
Name:ASTHMA AND PULMONARY DIAGNOSTIC ASSOCIATES
Entity Type:Organization
Organization Name:ASTHMA AND PULMONARY DIAGNOSTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-905-6436
Mailing Address - Street 1:707 WHITE HORSE PIKE STE D4
Mailing Address - Street 2:
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201-1462
Mailing Address - Country:US
Mailing Address - Phone:866-905-6436
Mailing Address - Fax:609-625-0174
Practice Address - Street 1:707 WHITE HORSE PIKE STE D4
Practice Address - Street 2:
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201-1462
Practice Address - Country:US
Practice Address - Phone:866-905-6436
Practice Address - Fax:609-625-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03975500207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty