Provider Demographics
NPI:1750443214
Name:PULMONARY AND SLEEP PHYSICIANS OF SOUTH JERSEY, PA
Entity Type:Organization
Organization Name:PULMONARY AND SLEEP PHYSICIANS OF SOUTH JERSEY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-778-4640
Mailing Address - Street 1:204 ARK RD BLDG I
Mailing Address - Street 2:STE 206
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3100
Mailing Address - Country:US
Mailing Address - Phone:856-778-4640
Mailing Address - Fax:856-778-0119
Practice Address - Street 1:204 ARK RD BLDG I
Practice Address - Street 2:STE 206
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3100
Practice Address - Country:US
Practice Address - Phone:856-778-4640
Practice Address - Fax:856-778-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2818604Medicaid
NJ2818604Medicaid