Healthcare Provider Details

I. General information

NPI: 1770448490
Provider Name (Legal Business Name): SUPREME SLEEP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 WILLOWBROOK BLVD
WAYNE NJ
07470-7032
US

IV. Provider business mailing address

155 WILLOWBROOK BLVD STE 110
WAYNE NJ
07470-7033
US

V. Phone/Fax

Practice location:
  • Phone: 609-736-0090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NEOLA GUSHWAY-HENRY
Title or Position: MD
Credential:
Phone: 609-736-0090