Provider Demographics
NPI:1376739672
Name:PEDIATRIC PULMONARY ASSOCIATES OF CENTRAL NEW JERSEY
Entity Type:Organization
Organization Name:PEDIATRIC PULMONARY ASSOCIATES OF CENTRAL NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-273-2300
Mailing Address - Street 1:33 OVERLOOK RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3570
Mailing Address - Country:US
Mailing Address - Phone:908-273-2300
Mailing Address - Fax:908-273-4320
Practice Address - Street 1:33 OVERLOOK RD
Practice Address - Street 2:SUITE 207
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3570
Practice Address - Country:US
Practice Address - Phone:908-273-2300
Practice Address - Fax:908-273-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA051421002080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6551602Medicaid
B15328Medicare UPIN