Healthcare Provider Details

I. General information

NPI: 1396859518
Provider Name (Legal Business Name): DIGITRACE CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1983 MARCUS AVE SUITE E-134
NEW HYDE PARK NY
11042-1016
US

IV. Provider business mailing address

200 CORPORATE PL SUITE 5B
PEABODY MA
01960-3840
US

V. Phone/Fax

Practice location:
  • Phone: 516-326-0629
  • Fax: 516-326-0516
Mailing address:
  • Phone: 978-536-7400
  • Fax: 978-535-9757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CARL R. IBERGER
Title or Position: EVP CFO
Credential:
Phone: 978-536-7400