Provider Demographics
NPI:1972647600
Name:PULMONARY REHABILITATION ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PULMONARY REHABILITATION ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:203-378-5501
Mailing Address - Street 1:1825 BARNUM AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-5333
Mailing Address - Country:US
Mailing Address - Phone:203-378-5501
Mailing Address - Fax:
Practice Address - Street 1:1825 BARNUM AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-5333
Practice Address - Country:US
Practice Address - Phone:203-378-5501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2279P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary RehabilitationGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03069Medicare PIN