Provider Demographics
NPI:1184673204
Name:PENN JERSEY PULMONARY ASSOCIATES, PC
Entity Type:Organization
Organization Name:PENN JERSEY PULMONARY ASSOCIATES, PC
Other - Org Name:CHARLES R. EGOVILLE, M.D., P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:V
Authorized Official - Last Name:FINKENSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-853-2025
Mailing Address - Street 1:52 W RED BANK AVE
Mailing Address - Street 2:SUITE 26
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1695
Mailing Address - Country:US
Mailing Address - Phone:856-853-2025
Mailing Address - Fax:856-845-8024
Practice Address - Street 1:52 W RED BANK AVE
Practice Address - Street 2:SUITE 26
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1695
Practice Address - Country:US
Practice Address - Phone:856-853-2025
Practice Address - Fax:856-845-8024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2015-03-09
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
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007778020017Medicaid
NJ3547001Medicaid
PA101589FDGMedicare ID - Type Unspecified
NJ047181PSWMedicare ID - Type Unspecified