Provider Demographics
NPI:1265656615
Name:PULMONARY MEDICINE OF WAYNE PC
Entity type:Organization
Organization Name:PULMONARY MEDICINE OF WAYNE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIVIU
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPPAPORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-956-1404
Mailing Address - Street 1:508 HAMBURG TPKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-8482
Mailing Address - Country:US
Mailing Address - Phone:973-956-1404
Mailing Address - Fax:973-956-1646
Practice Address - Street 1:508 HAMBURG TPKE
Practice Address - Street 2:SUITE 202
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8482
Practice Address - Country:US
Practice Address - Phone:973-956-1404
Practice Address - Fax:973-956-1646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA57242207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2720576004OtherAMERIHEALTH
NJ9C1761OtherWELLCARE
NJJ5518OtherHORIZON HMO BLUE
NJAMERIGROUPOtherAMERIGROUP
NJ2K2751OtherHEALTHNET
NJ3060227OtherAETNA
NJ2720576000OtherAMERIHEALTH
NJP782845OtherOXFORD
NJ068158Medicaid
NJ9C1761OtherWELLCARE
NJ=========OtherUNITED HEALTHCARE
NJ3060227OtherAETNA
NJJ5518OtherHORIZON HMO BLUE
NJ068158Medicaid