Provider Demographics
NPI:1720197890
Name:PULMONARY AND SLEEP MEDICINE OF CENTRAL PA PC
Entity Type:Organization
Organization Name:PULMONARY AND SLEEP MEDICINE OF CENTRAL PA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:ILLUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-375-5305
Mailing Address - Street 1:145 HOSPITAL AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:DUBOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801
Mailing Address - Country:US
Mailing Address - Phone:814-375-5305
Mailing Address - Fax:814-375-5307
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:STE 101
Practice Address - City:DUBOIS
Practice Address - State:PA
Practice Address - Zip Code:15801
Practice Address - Country:US
Practice Address - Phone:814-375-5305
Practice Address - Fax:814-375-5307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1695OtherGEISINGER
PA1013140640002Medicaid
PA093151Medicare PIN