Provider Demographics
NPI:1972809390
Name:INSTITUTE OF PULMONARY MEDICINE, LLC
Entity Type:Organization
Organization Name:INSTITUTE OF PULMONARY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENUKA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MAPITIGAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-312-5243
Mailing Address - Street 1:26 CHESTNUT RIDGE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1825
Mailing Address - Country:US
Mailing Address - Phone:201-312-5243
Mailing Address - Fax:201-444-8560
Practice Address - Street 1:1 W RIDGEWOOD AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2359
Practice Address - Country:US
Practice Address - Phone:201-312-5243
Practice Address - Fax:201-444-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07536900207R00000X, 207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI65456Medicare UPIN