Provider Demographics
NPI:1770646770
Name:ATLANTIC SHORE PUL ASSOC
Entity Type:Organization
Organization Name:ATLANTIC SHORE PUL ASSOC
Other - Org Name:ATLANTIC SHORE PULMONARY AND SLEEP MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:COSTANTINI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-926-1450
Mailing Address - Street 1:18 W NEW YORK AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:609-926-1450
Mailing Address - Fax:609-926-8419
Practice Address - Street 1:18 W NEW YORK AVENUE
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244
Practice Address - Country:US
Practice Address - Phone:609-926-1450
Practice Address - Fax:609-926-8419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Not Answered207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0038145OtherAETNA
NJ0091693000OtherAMERIHEALTH
NJCF1748OtherTRAVELERS MEDICARE
NJ3365409Medicaid
NJ3365409Medicaid
NJ3365409Medicaid