Healthcare Provider Details

I. General information

NPI: 1033278957
Provider Name (Legal Business Name): ATLANTIC PULMONARY AND SLEEP DISORDERS ASSOCIATION PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MULE RD UNIT15
TOMS RIVER NJ
08757
US

IV. Provider business mailing address

873 GOOSE CREEK RD
TOMS RIVER NJ
08753-3621
US

V. Phone/Fax

Practice location:
  • Phone: 609-660-8100
  • Fax:
Mailing address:
  • Phone: 732-727-7103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMA07931500
License Number StateNJ

VIII. Authorized Official

Name: AGNIESZKA PALECKI
Title or Position: PRESIDENT
Credential: MD
Phone: 732-727-7103