Healthcare Provider Details

I. General information

NPI: 1184745192
Provider Name (Legal Business Name): HACKENSACK SLEEP & PULMONARY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/30/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 PROSPECT AVE STE 20
HACKENSACK NJ
07601-1840
US

IV. Provider business mailing address

170 PROSPECT AVENUE SUITE 20
HACKENSACK NJ
07601-1840
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-0232
  • Fax: 201-996-0095
Mailing address:
  • Phone: 201-996-0232
  • Fax: 201-996-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0117668
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MR. FARIBORZ ASHTYANI
Title or Position: DIRECTOR
Credential:
Phone: 201-996-0232