Healthcare Provider Details

I. General information

NPI: 1518299833
Provider Name (Legal Business Name): PULMONARY SLEEP CARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 JERSEY AVENUE SUITE 470
JERSEY CITY NJ
07302
US

IV. Provider business mailing address

PO BOX 1557
LIVINGSTON NJ
07039-7157
US

V. Phone/Fax

Practice location:
  • Phone: 201-918-2239
  • Fax: 201-918-2243
Mailing address:
  • Phone: 201-918-2239
  • Fax: 201-918-2243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: RAO S MIKKILINENI
Title or Position: OWNER/ASSOCIATE
Credential: M.D.
Phone: 201-918-2239