Healthcare Provider Details

I. General information

NPI: 1396176152
Provider Name (Legal Business Name): COMPLETE SLEEP MEDICINE CARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 NEWBRIDGE RD
HICKSVILLE NY
11801-2853
US

IV. Provider business mailing address

7 NEWBRIDGE RD
HICKSVILLE NY
11801-2853
US

V. Phone/Fax

Practice location:
  • Phone: 516-605-1136
  • Fax: 516-605-1139
Mailing address:
  • Phone: 516-605-1136
  • Fax: 516-605-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number242650
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02916986
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: RAZI HUSSAINI
Title or Position: SLEEP MEDICINE
Credential: MD
Phone: 917-969-2881