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General NPI Number Information
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NPI Number | 1679653109
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Entity Type | Organization
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Legal Business Name | SLEEP LAB OF NORTHEASTERN PA
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 231 NORTHERN BLVD SUITE 2
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City | CLARKS SUMMIT
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State | PA
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Zip | 18411-9189
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Country | US
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Telephone | 570-585-6220
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Fax | 570-585-6234
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Provider Business Mailing Address
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Address Line | 231 NORTHERN BLVD SUITE 2
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City | CLARKS SUMMIT
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State | PA
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Zip | 18411-9189
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Country | US
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Telephone | 570-585-6220
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Fax | 570-585-6234
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MR. DAVID P. WASHO
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Credential | RPSGT, RRT
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Telephone | 570-585-6220
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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 |
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License Number State |
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