Provider Demographics
NPI:1063450484
Name:PULMONARY HEALTH PHYSICIANS PC
Entity type:Organization
Organization Name:PULMONARY HEALTH PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-732-9368
Mailing Address - Street 1:945 E GENESEE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1752
Mailing Address - Country:US
Mailing Address - Phone:315-475-8401
Mailing Address - Fax:315-475-0824
Practice Address - Street 1:945 E GENESEE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1752
Practice Address - Country:US
Practice Address - Phone:315-475-8401
Practice Address - Fax:315-475-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00485070Medicaid
NY00485070Medicaid