Healthcare Provider Details

I. General information

NPI: 1871815720
Provider Name (Legal Business Name): AMERICAN PULMONARY & SLEEP MEDICINE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W RIDGEWOOD AVE SUITE 203
PARAMUS NJ
07652-2359
US

IV. Provider business mailing address

26 CHESTNUT RIDGE RD SUITE 103
MONTVALE NJ
07645-1825
US

V. Phone/Fax

Practice location:
  • Phone: 201-312-5243
  • Fax: 201-444-8560
Mailing address:
  • Phone: 201-312-5243
  • Fax: 201-444-8560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA07536900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number25MA07536900
License Number StateNJ

VIII. Authorized Official

Name: RENUKA N MAPITIGAMA
Title or Position: MD
Credential: MD
Phone: 201-967-8425