Healthcare Provider Details

I. General information

NPI: 1164504999
Provider Name (Legal Business Name): VECTOR SLEEP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6260 99 ST #26
REEGO PARK NY
11374-1842
US

IV. Provider business mailing address

6260 99 ST UNIT #26
REEGO PARK NY
11374-1842
US

V. Phone/Fax

Practice location:
  • Phone: 718-830-2800
  • Fax: 718-830-2504
Mailing address:
  • Phone: 718-830-2800
  • Fax: 718-830-2504

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. VASSILI KISSELEV
Title or Position: PRESIDENT
Credential: RT
Phone: 718-830-2800