Provider Demographics
NPI:1962576157
Name:NORTHERN NEW JERSEY PULMONARY ASSOCIATES PC
Entity type:Organization
Organization Name:NORTHERN NEW JERSEY PULMONARY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:POLKOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-498-1311
Mailing Address - Street 1:211 ESSEX ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3231
Mailing Address - Country:US
Mailing Address - Phone:201-498-1311
Mailing Address - Fax:201-498-1312
Practice Address - Street 1:211 ESSEX ST
Practice Address - Street 2:SUITE 302
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3231
Practice Address - Country:US
Practice Address - Phone:201-498-1311
Practice Address - Fax:201-498-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7230109Medicaid
NJ7230109Medicaid