Healthcare Provider Details

I. General information

NPI: 1972093342
Provider Name (Legal Business Name): GOOD KNIGHTS SLEEP CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 MOUNT CARMEL AVE
GLENSIDE PA
19038-4709
US

IV. Provider business mailing address

2217 MOUNT CARMEL AVE
GLENSIDE PA
19038-4709
US

V. Phone/Fax

Practice location:
  • Phone: 215-884-1595
  • Fax: 215-884-3947
Mailing address:
  • Phone: 215-884-1595
  • Fax: 215-884-3947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StatePA

VIII. Authorized Official

Name: DR. GARY NEWELL
Title or Position: OWNER
Credential: DDS
Phone: 158-841-5952