Provider Demographics
NPI:1689856759
Name:LIBERTY PULMONARY CRITICAL CARE
Entity type:Organization
Organization Name:LIBERTY PULMONARY CRITICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAO
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKKILINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-795-9155
Mailing Address - Street 1:PO BOX 1557
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-7157
Mailing Address - Country:US
Mailing Address - Phone:973-202-6120
Mailing Address - Fax:
Practice Address - Street 1:355 GRAND ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4321
Practice Address - Country:US
Practice Address - Phone:201-795-9155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty