Provider Demographics
NPI:1275550923
Name:PULMONARY AFFILIATES OF SOUTH JERSEY INC
Entity Type:Organization
Organization Name:PULMONARY AFFILIATES OF SOUTH JERSEY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIPAKKUMAR
Authorized Official - Middle Name:PURUSHOTTAM
Authorized Official - Last Name:MALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-427-4477
Mailing Address - Street 1:1416 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3649
Mailing Address - Country:US
Mailing Address - Phone:609-471-1000
Mailing Address - Fax:856-427-9199
Practice Address - Street 1:140 E EVESHAM RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3949
Practice Address - Country:US
Practice Address - Phone:856-427-4477
Practice Address - Fax:856-427-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07352400207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Not Answered207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084201Medicare ID - Type Unspecified