=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528426707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISLAND SLEEP SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2016
-----------------------------------------------------
Last Update Date | 02/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 WINDSOR RD
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10314-4541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-876-9100
-----------------------------------------------------
Fax | 718-876-8888
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 WINDSOR RD
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10314-4541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-876-9100
-----------------------------------------------------
Fax | 718-876-8888
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOSEPH THOMAS MORMINO
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 718-876-9100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number | 042434
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------