Provider Demographics
NPI:1093751588
Name:PEDIATRIC PULMONARY & ASTHMA ASSOCIATES OF SOUTH JERSEY, LLC
Entity Type:Organization
Organization Name:PEDIATRIC PULMONARY & ASTHMA ASSOCIATES OF SOUTH JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:VITO
Authorized Official - Last Name:SALVIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:609-677-4566
Mailing Address - Street 1:1750 ZION RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1844
Mailing Address - Country:US
Mailing Address - Phone:609-677-4566
Mailing Address - Fax:609-677-6080
Practice Address - Street 1:1750 ZION RD
Practice Address - Street 2:SUITE 107
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1844
Practice Address - Country:US
Practice Address - Phone:609-677-4566
Practice Address - Fax:609-677-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB044249002080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60009925OtherHORIZON NEW JERSEY HEALTH
NJ0047465Medicaid
NJ1675149OtherAMERIHEALTH ADMINISTRATOR
NJ2349831000OtherAMERIHEALTH