Provider Demographics
NPI:1699953190
Name:CHEST & INTENSIVE CARE MEDICINE, L.L.C.
Entity type:Organization
Organization Name:CHEST & INTENSIVE CARE MEDICINE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-873-9682
Mailing Address - Street 1:35 CLYDE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5033
Mailing Address - Country:US
Mailing Address - Phone:732-873-9682
Mailing Address - Fax:
Practice Address - Street 1:35 CLYDE RD STE 105
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5033
Practice Address - Country:US
Practice Address - Phone:732-873-9682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty