Provider Demographics
NPI:1295789113
Name:GARDEN STATE PULMONARY ASSOCIATES
Entity type:Organization
Organization Name:GARDEN STATE PULMONARY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SALM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-596-9057
Mailing Address - Street 1:520 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4804
Mailing Address - Country:US
Mailing Address - Phone:856-596-9057
Mailing Address - Fax:856-596-0837
Practice Address - Street 1:520 LIPPINCOTT DR
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4804
Practice Address - Country:US
Practice Address - Phone:856-596-9057
Practice Address - Fax:856-596-0837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3361900Medicaid
NJ0038294OtherAETNA
NJB7268OtherRAILROAD MEDICARE
NJ0116035000OtherAMERIHEALTH HMO
NJ0116035000OtherAMERIHEALTH HMO