MEDICARE: PEDIATRIC PULMONARY & ASTHMA ASSOCIATES OF SOUTH JERSEY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0214X	Pediatric Pulmonology Physician	25MB04424900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60009925	OTHER	NJ	HORIZON NEW JERSEY HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1675149	OTHER	NJ	AMERIHEALTH ADMINISTRATOR
4	2349831000	OTHER	NJ	AMERIHEALTH

General Provider Information

NPI Number	:	1093751588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC PULMONARY & ASTHMA ASSOCIATES OF SOUTH JERSEY, LLC

Provider Business Mailing Address
First Line	:	1750 ZION RD
Second Line	:	SUITE 107
City	:	NORTHFIELD
State	:	NJ
Zip	:	08225-1844
Country	:	US
Telephone Number	:	609-677-4566
Fax Number	:	609-677-6080

Provider Business Practice Location Address
First Line	:	1750 ZION RD
Second Line	:	SUITE 107
City	:	NORTHFIELD
State	:	NJ
Zip	:	08225-1844
Country	:	US
Telephone Number	:	609-677-4566
Fax Number	:	609-677-6080

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DR. JOSEPH VITO SALVIA JR.
Credential	:	D.O.
Telephone Number	:	609-677-4566

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	08/22/2020

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