Provider Demographics
NPI:1710958244
Name:CENTRAL JERSEY PULMONARY & MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CENTRAL JERSEY PULMONARY & MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:BEBAWY
Authorized Official - Suffix:
Authorized Official - Credentials:MD FCCP
Authorized Official - Phone:732-264-1001
Mailing Address - Street 1:719 N BEERS ST
Mailing Address - Street 2:SUITES 2E & 2F
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733
Mailing Address - Country:US
Mailing Address - Phone:732-264-1001
Mailing Address - Fax:732-264-4495
Practice Address - Street 1:719 N BEERS ST
Practice Address - Street 2:SUITES 2E & 2F
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733
Practice Address - Country:US
Practice Address - Phone:732-264-1001
Practice Address - Fax:732-264-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0050687Medicaid