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General NPI Number Information
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NPI Number | 1447261870
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Entity Type | Organization
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Legal Business Name | NORTHEAST INSOMNIA AND SLEEP MEDICINE,PLLC
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 5947 AMBOY RD. SECOND FLOOR
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City | STATEN ISLAND
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State | NY
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Zip | 10309-3118
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Country | US
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Telephone | 718-605-2970
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Fax | 718-605-7180
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Provider Business Mailing Address
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Address Line | 4 SQUAN SONG LANE SECOND FLOOR
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City | COLTS NECK
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State | NY
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Zip | 07722-1820
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Country | US
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Telephone | 718-605-2970
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Fax | 718-605-7180
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Authorized Official
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Title or Position | DIRECTOR
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Name | AHMED ALY ABDELFADIL
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Credential | M.D.
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Telephone | 718-761-2950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 196563
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 196563
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License Number State | NY
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