=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891015541
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLEEPTECH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2010
-----------------------------------------------------
Last Update Date | 06/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4051 BROAD ST SUITE 122
-----------------------------------------------------
City | SAN LUIS OBISPO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93401-8714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-352-1111
-----------------------------------------------------
Fax | 805-352-1120
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1680 ROUTE 23 SUITE 400
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07470-7501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-838-6444
-----------------------------------------------------
Fax | 973-850-7118
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTROLLER
-----------------------------------------------------
Name | MR. GLENN MIGLIORINO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-838-6444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------