Healthcare Provider Details

I. General information

NPI: 1912059577
Provider Name (Legal Business Name): NEWARK OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CONTINENTAL DRIVE SUITE 112
NEWARK DE
19713-4369
US

IV. Provider business mailing address

200 CONTINENTAL DR STE 122
NEWARK DE
19713-4303
US

V. Phone/Fax

Practice location:
  • Phone: 302-366-0111
  • Fax: 302-366-0110
Mailing address:
  • Phone: 302-366-0111
  • Fax: 302-366-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID SHAPOURI
Title or Position: ADMINISTRATOR
Credential:
Phone: 443-254-4161