Healthcare Provider Details

I. General information

NPI: 1932376027
Provider Name (Legal Business Name): PULMOHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 LEXINGTON AVE
CLIFTON NJ
07011-1226
US

IV. Provider business mailing address

575 LEXINGTON AVE
CLIFTON NJ
07011-1226
US

V. Phone/Fax

Practice location:
  • Phone: 973-390-3191
  • Fax: 707-221-7688
Mailing address:
  • Phone: 973-390-3191
  • Fax: 707-221-7688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateNJ
# 7
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. JUAN JOSE RIVERA
Title or Position: CEO
Credential: RRT
Phone: 973-390-3191