=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639209638
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLEEP CARE ENTERPRISES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1212 N COUNTRY RD SUITE 4B
-----------------------------------------------------
City | STONY BROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11790-1919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-246-9000
-----------------------------------------------------
Fax | 631-689-1359
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1212 N COUNTRY RD SUITE 4B
-----------------------------------------------------
City | STONY BROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11790-1919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-246-9000
-----------------------------------------------------
Fax | 631-689-1359
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | STEPHEN L FREDERICO
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 631-246-9000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------