Provider Demographics
NPI:1194803106
Name:UNIVERSITY RESPIRATORY MEDICINE PA
Entity type:Organization
Organization Name:UNIVERSITY RESPIRATORY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KONIARIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-487-4595
Mailing Address - Street 1:75 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-8504
Mailing Address - Country:US
Mailing Address - Phone:201-487-4595
Mailing Address - Fax:201-487-0641
Practice Address - Street 1:75 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8504
Practice Address - Country:US
Practice Address - Phone:201-487-4595
Practice Address - Fax:201-487-0641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
068088Medicare PIN