Healthcare Provider Details

I. General information

NPI: 1689839706
Provider Name (Legal Business Name): WILLOW SLEEP CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 FRANKLIN CORNER ROAD
LAWRENCEVILLE NJ
08690
US

IV. Provider business mailing address

136 FRANKLIN CORNER ROAD
LAWRENCVILLE NJ
08648
US

V. Phone/Fax

Practice location:
  • Phone: 609-586-9050
  • Fax: 609-585-4902
Mailing address:
  • Phone: 609-586-9050
  • Fax: 609-585-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELE MIGLIACCIO
Title or Position: MANAGER
Credential:
Phone: 609-586-9050