Basic Information
| Provider Information | |||||||||
| NPI: | 1306003959 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SLEEP AMERICA MEDICAL PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1911 RICHMOND AVE | ||||||||
| Address2: | STE N2ND | ||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103143913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186456434 | ||||||||
| FaxNumber: | 7183825252 | ||||||||
| Practice Location | |||||||||
| Address1: | 1911 RICHMOND AVE | ||||||||
| Address2: | STE N2ND | ||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103143913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186456434 | ||||||||
| FaxNumber: | 7183825252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2008 | ||||||||
| LastUpdateDate: | 05/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | PRAHBHAT | ||||||||
| AuthorizedOfficialFirstName: | SONI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7186456434 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | 192569 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
ID Information
| ID | Type | State | Issuer | Description | 02236428 | 05 | NY | MEDICAID |