Provider Demographics
NPI:1093734022
Name:PULMONARY AND SLEEP ASSOCIATES OF SOUTH JERSEY, LLC
Entity Type:Organization
Organization Name:PULMONARY AND SLEEP ASSOCIATES OF SOUTH JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-429-1800
Mailing Address - Street 1:107 BERLIN RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3526
Mailing Address - Country:US
Mailing Address - Phone:856-429-1800
Mailing Address - Fax:856-429-1081
Practice Address - Street 1:107 BERLIN RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3526
Practice Address - Country:US
Practice Address - Phone:856-429-1800
Practice Address - Fax:856-429-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7351101Medicaid
NJ7351101Medicaid