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General NPI Number Information
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NPI Number | 1306003959
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Entity Type | Organization
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Legal Business Name | SLEEP AMERICA MEDICAL PC
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 1911 RICHMOND AVE STE N2ND
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3913
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Country | US
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Telephone | 718-645-6434
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Fax | 718-382-5252
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Provider Business Mailing Address
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Address Line | 1911 RICHMOND AVE STE N2ND
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3913
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Country | US
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Telephone | 718-645-6434
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Fax | 718-382-5252
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Authorized Official
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Title or Position | OWNER
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Name | MR. SONI PRAHBHAT
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Credential | MD
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Telephone | 718-645-6434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number | 192569
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License Number State | NY
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