Healthcare Provider Details

I. General information

NPI: 1679239990
Provider Name (Legal Business Name): SOUTH ORANGE SLEEP SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 S ORANGE AVE
SOUTH ORANGE NJ
07079-2642
US

IV. Provider business mailing address

481 S ORANGE AVE
SOUTH ORANGE NJ
07079-2642
US

V. Phone/Fax

Practice location:
  • Phone: 973-762-2660
  • Fax: 973-762-5473
Mailing address:
  • Phone: 973-762-2660
  • Fax: 973-762-5473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: HANIEL ROSEMOND
Title or Position: OWNER
Credential: DDS, FAGD
Phone: 973-762-2660