Healthcare Provider Details

I. General information

NPI: 1770755639
Provider Name (Legal Business Name): METROPOLITAN SLEEP AND DIAGNOSTIC TESTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

596 ANDERSON AVE SUITE 203
CLIFFSIDE PARK NJ
07010-1831
US

IV. Provider business mailing address

596 ANDERSON AVE SUITE 203
CLIFFSIDE PARK NJ
07010-1831
US

V. Phone/Fax

Practice location:
  • Phone: 201-840-7533
  • Fax: 201-313-4535
Mailing address:
  • Phone: 201-840-7533
  • Fax: 201-313-4535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA04969400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MB08234500
License Number StateNJ

VIII. Authorized Official

Name: MR. GEORGE J BUSSANICH
Title or Position: OWNER
Credential:
Phone: 201-840-7533