Healthcare Provider Details

I. General information

NPI: 1528097425
Provider Name (Legal Business Name): PULMOCAIR RESPIRATORY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 09/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 NW 17TH AVE 106
DELRAY BEACH FL
33445-2522
US

IV. Provider business mailing address

755 NW 17TH AVE 106
DELRAY BEACH FL
33445-2522
US

V. Phone/Fax

Practice location:
  • Phone: 561-274-9664
  • Fax: 561-265-4320
Mailing address:
  • Phone: 561-274-9664
  • Fax: 561-265-4320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number1313247
License Number StateFL

VIII. Authorized Official

Name: JONATHAN JAMES FEDELE
Title or Position: PRESIDENT
Credential:
Phone: 561-274-9664