Provider Demographics
NPI:1376527812
Name:PULMONARY & CRITICAL CARE CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:PULMONARY & CRITICAL CARE CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:I
Authorized Official - Last Name:HENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-593-9500
Mailing Address - Street 1:444 MERRICK ROAD
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563
Mailing Address - Country:US
Mailing Address - Phone:516-593-9500
Mailing Address - Fax:516-593-9048
Practice Address - Street 1:444 MERRICK ROAD
Practice Address - Street 2:SUITE LL1
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563
Practice Address - Country:US
Practice Address - Phone:516-593-9500
Practice Address - Fax:516-593-9048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01091689Medicaid
NY01091689Medicaid