Healthcare Provider Details

I. General information

NPI: 1306967401
Provider Name (Legal Business Name): CENTER FOR SLEEP MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 GERMANTOWN PIKE
LAFAYETTE HILL PA
19444-1813
US

IV. Provider business mailing address

443 GERMANTOWN PIKE
LAFAYETTE HILL PA
19444-1813
US

V. Phone/Fax

Practice location:
  • Phone: 610-828-4060
  • Fax:
Mailing address:
  • Phone: 610-828-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

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