=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932134574
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AHB PULMONARY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 E 80TH ST SUITE 1D
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-0117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-535-3622
-----------------------------------------------------
Fax | 212-452-2808
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 E 80TH ST SUITE 1D
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-0117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-535-3622
-----------------------------------------------------
Fax | 212-452-2808
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JACK JOSEPH ADLER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-535-3622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 98677
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------