Healthcare Provider Details

I. General information

NPI: 1790991487
Provider Name (Legal Business Name): SLEEP AND BREATHING DIOGNOSTIC LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 PATERSON PLANK RD
SECAUCUS NJ
07094-3734
US

IV. Provider business mailing address

1324 PATERSON PLANK RD
SECAUCUS NJ
07094-3734
US

V. Phone/Fax

Practice location:
  • Phone: 201-520-0199
  • Fax: 201-520-0201
Mailing address:
  • Phone: 201-520-0199
  • Fax: 201-520-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA04283700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number25MA04283700
License Number StateNJ

VIII. Authorized Official

Name: JOSE R. SANCHEZ-PENA
Title or Position: OWNER
Credential: M.D.
Phone: 201-520-0199