Healthcare Provider Details

I. General information

NPI: 1992007587
Provider Name (Legal Business Name): CARDIO SLEEP SOLUTIONS CALIFORNIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 STATE ROUTE 18
OLD BRIDGE NJ
08857-1420
US

IV. Provider business mailing address

30 STATE ROUTE 18
OLD BRIDGE NJ
08857-1420
US

V. Phone/Fax

Practice location:
  • Phone: 732-261-2859
  • Fax:
Mailing address:
  • Phone: 732-261-2859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI20783
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDI20783
License Number StateNJ

VIII. Authorized Official

Name: DR. AVI WEISFOGEL
Title or Position: PRESIDENT
Credential: DDS
Phone: 973-261-2859