Healthcare Provider Details

I. General information

NPI: 1538473020
Provider Name (Legal Business Name): HACKENSACK SLEEP INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 PROSPECT AVE
HACKENSACK NJ
07601-1820
US

IV. Provider business mailing address

170 PROSPECT AVENUE
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-0170
  • Fax: 201-996-0095
Mailing address:
  • Phone: 201-996-0170
  • Fax: 201-996-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1438770
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. FARIBORZ ASHTYANI
Title or Position: PRESIDENT
Credential:
Phone: 201-996-0170