Provider Demographics
NPI:1053401331
Name:PULMONARY CRITICAL CARE SLEEP ASSOCIATES PC
Entity type:Organization
Organization Name:PULMONARY CRITICAL CARE SLEEP ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:ISLAM
Authorized Official - Last Name:SIDDIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-587-9944
Mailing Address - Street 1:1700 WHITEHORSE HAMILTON SQUARE RD
Mailing Address - Street 2:SUITE C-4
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3536
Mailing Address - Country:US
Mailing Address - Phone:609-587-9944
Mailing Address - Fax:609-587-9955
Practice Address - Street 1:1700 WHITEHORSE HAMILTON SQUARE RD
Practice Address - Street 2:SUITE C-4
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3536
Practice Address - Country:US
Practice Address - Phone:609-587-9944
Practice Address - Fax:609-587-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05852900207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Not Answered207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5548608Medicaid
NJ5548608Medicaid
NJF43060Medicare UPIN