Provider Demographics
NPI:1710088422
Name:PULMONARY & CRITICAL CARE ASSOCIATES,LLC
Entity Type:Organization
Organization Name:PULMONARY & CRITICAL CARE ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-964-1964
Mailing Address - Street 1:2333 MORRIS AVENUE
Mailing Address - Street 2:SUITE A1
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5746
Mailing Address - Country:US
Mailing Address - Phone:908-964-1964
Mailing Address - Fax:908-964-6286
Practice Address - Street 1:2333 MORRIS AVENUE
Practice Address - Street 2:SUITE A1
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5746
Practice Address - Country:US
Practice Address - Phone:908-964-1964
Practice Address - Fax:908-964-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3225003Medicaid
NJ872563Medicare PIN