Basic Information
| Provider Information | |||||||||
| NPI: | 1639406044 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONNECTICUT SLEEP MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4131 | ||||||||
| Address2: | |||||||||
| City: | YALESVILLE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064921481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032841340 | ||||||||
| FaxNumber: | 2032654557 | ||||||||
| Practice Location | |||||||||
| Address1: | 61 POMEROY AVE | ||||||||
| Address2: | |||||||||
| City: | MERIDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064507101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036948760 | ||||||||
| FaxNumber: | 2032654557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2009 | ||||||||
| LastUpdateDate: | 11/05/2009 | ||||||||
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| AuthorizedOfficialLastName: | VOLPE | ||||||||
| AuthorizedOfficialFirstName: | BRETT | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 20328413401 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
No ID Information.