Provider Demographics
NPI:1306849229
Name:PROFESSIONAL PULMONARY SERVICE, INC
Entity Type:Organization
Organization Name:PROFESSIONAL PULMONARY SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-848-1146
Mailing Address - Street 1:27 E CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2415
Mailing Address - Country:US
Mailing Address - Phone:856-848-2440
Mailing Address - Fax:856-853-1146
Practice Address - Street 1:27 E CENTRE ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-2415
Practice Address - Country:US
Practice Address - Phone:856-848-2440
Practice Address - Fax:856-853-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
0002629000OtherKEYSTONE HEALTH PLANS
000200291OtherAMERIHEALTH PPO
NJ2901501Medicaid
0017453OtherAETNA/USHC
NJ2901501Medicaid