Healthcare Provider Details

I. General information

NPI: 1730593948
Provider Name (Legal Business Name): PULMONARY AND CRITICAL CARE CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BETHANY RD BUILDING 6 SUITE 85
HAZLET NJ
07730-1663
US

IV. Provider business mailing address

PO BOX 384
HOLMDEL NJ
07733-0384
US

V. Phone/Fax

Practice location:
  • Phone: 732-264-5005
  • Fax: 732-264-1843
Mailing address:
  • Phone: 732-264-5005
  • Fax: 732-264-1843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MONA AWAD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 732-264-5005