Provider Demographics
NPI:1346408788
Name:PULMONARY FUNCTION COOPERATIVE LLC
Entity Type:Organization
Organization Name:PULMONARY FUNCTION COOPERATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:LINDA
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1203-804-1773
Mailing Address - Street 1:574 SKIFF ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3014
Mailing Address - Country:US
Mailing Address - Phone:203-804-1773
Mailing Address - Fax:203-281-6780
Practice Address - Street 1:574 SKIFF ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3014
Practice Address - Country:US
Practice Address - Phone:203-804-1773
Practice Address - Fax:203-281-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-31
Last Update Date:2008-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024635171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty