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General NPI Number Information
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NPI Number | 1518197847
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Entity Type | Organization
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Legal Business Name | POLY-TECH SLEEP SERVICES LLC
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 1718 WELSH RD SECOND FLOOR, SUITE C
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City | PHILADELPHIA
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State | PA
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Zip | 19115-4213
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Country | US
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Telephone | 215-676-2334
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Fax | 215-676-2366
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Provider Business Mailing Address
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Address Line | 1718 WELSH RD SECOND FLOOR, SUITE C
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City | PHILADELPHIA
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State | PA
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Zip | 19115-4213
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Country | US
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Telephone | 215-676-2334
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Fax | 215-676-2366
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. PRABHAKARA R TUMPATI
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Credential | M.D.
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Telephone | 267-864-6101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | MD432380
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RB0002X
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Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
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License Number | MD432380
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number | YM005236L
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License Number State | PA
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