Healthcare Provider Details

I. General information

NPI: 1477937993
Provider Name (Legal Business Name): NORTH EASTERN SLEEP MASTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E END CTR
WILKES BARRE PA
18702-6968
US

IV. Provider business mailing address

20 E END CTR
WILKES BARRE PA
18702-6968
US

V. Phone/Fax

Practice location:
  • Phone: 570-208-5305
  • Fax: 570-208-5626
Mailing address:
  • Phone: 570-208-5305
  • Fax: 570-208-5626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ANTHONY J POLIT
Title or Position: OWNER
Credential: DMD
Phone: 570-208-5305