Healthcare Provider Details

I. General information

NPI: 1750443214
Provider Name (Legal Business Name): PULMONARY AND SLEEP PHYSICIANS OF SOUTH JERSEY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 ARK RD BLDG I STE 206
MOUNT LAUREL NJ
08054-3100
US

IV. Provider business mailing address

204 ARK RD BLDG I STE 206
MOUNT LAUREL NJ
08054-3100
US

V. Phone/Fax

Practice location:
  • Phone: 856-778-4640
  • Fax: 856-778-0119
Mailing address:
  • Phone: 856-778-4640
  • Fax: 856-778-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHLEEN RYAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 856-778-4640