Provider Demographics
NPI:1922146216
Name:PULMONARY ICU MEDICAL PLLC
Entity Type:Organization
Organization Name:PULMONARY ICU MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PELKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-232-5590
Mailing Address - Street 1:68 W CEDAR ST STE 2
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1300
Mailing Address - Country:US
Mailing Address - Phone:845-232-5590
Mailing Address - Fax:845-232-5588
Practice Address - Street 1:68 W CEDAR ST STE 2
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1300
Practice Address - Country:US
Practice Address - Phone:845-232-5590
Practice Address - Fax:845-232-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207RC0200X
207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20N821Medicare ID - Type UnspecifiedMEDICARE LEGACY
NY2E9811Medicare ID - Type UnspecifiedMEDICARE LEGACY
NYG44472Medicare UPIN
NYP86683Medicare UPIN
NY796961Medicare ID - Type UnspecifiedMEDICARE LEGACY
NYH00588Medicare UPIN