Healthcare Provider Details

I. General information

NPI: 1649417213
Provider Name (Legal Business Name): TRI STATE SLEEP CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2009
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 PENNSYLVANIA AVE SUITE B
WEIRTON WV
26062-4029
US

IV. Provider business mailing address

3710 PENNSYLVANIA AVE SUITE B
WEIRTON WV
26062-4029
US

V. Phone/Fax

Practice location:
  • Phone: 304-224-1230
  • Fax:
Mailing address:
  • Phone: 304-224-1230
  • Fax:

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: KRISHAN K AGGARWAL
Title or Position: PRESIDENT
Credential: MD
Phone: 304-723-2430