Healthcare Provider Details

I. General information

NPI: 1366873259
Provider Name (Legal Business Name): DELTA SLEEP CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

994 W JERICHO TPKE
SMITHTOWN NY
11787-3235
US

IV. Provider business mailing address

994 W JERICHO TPKE
SMITHTOWN NY
11787-3235
US

V. Phone/Fax

Practice location:
  • Phone: 631-787-2386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. LISA TAUGER
Title or Position: DIRECTOR
Credential:
Phone: 631-427-1818