Provider Demographics
NPI:1366531634
Name:PULMONARY AND INTENSIVE CARE SPECIALISTS OF NEW JERSEY
Entity type:Organization
Organization Name:PULMONARY AND INTENSIVE CARE SPECIALISTS OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:HARANGOZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-613-8880
Mailing Address - Street 1:593 CRANBURY ROAD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-613-8880
Mailing Address - Fax:732-613-0077
Practice Address - Street 1:593 CRANBURY ROAD
Practice Address - Street 2:SUITE 1A
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-613-8880
Practice Address - Fax:732-613-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5362105Medicaid
NJ720256Medicare PIN