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General NPI Number Information
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NPI Number | 1891016176
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Entity Type | Organization
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Legal Business Name | NUTMEG SLEEP LAB
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Dates
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Enumeration Date | 06/21/2010
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Last Update Date | 06/21/2010
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Provider Practice Location Address
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Address Line | 478 BURNSIDE AVE
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City | EAST HARTFORD
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State | CT
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Zip | 06108-2406
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Country | US
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Telephone | 870-528-7161
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Fax | 860-528-7163
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Provider Business Mailing Address
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Address Line | 478 BURNSIDE AVE
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City | EAST HARTFORD
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State | CT
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Zip | 06108-2406
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Country | US
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Telephone | 870-528-7161
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Fax | 860-528-7163
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Authorized Official
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Title or Position | OWNER
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Name | MAHMOOD HASAN YEKTA
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Credential | M.D.
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Telephone | 860-528-7161
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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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