Provider Demographics
NPI:1518299833
Name:PULMONARY SLEEP CARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PULMONARY SLEEP CARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:RAO
Authorized Official - Middle Name:S
Authorized Official - Last Name:MIKKILINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-918-2239
Mailing Address - Street 1:PO BOX 1557
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-7157
Mailing Address - Country:US
Mailing Address - Phone:201-918-2239
Mailing Address - Fax:201-918-2243
Practice Address - Street 1:377 JERSEY AVENUE
Practice Address - Street 2:SUITE 470
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302
Practice Address - Country:US
Practice Address - Phone:201-918-2239
Practice Address - Fax:201-918-2243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty