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General NPI Number Information
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NPI Number | 1992796734
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Entity Type | Organization
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Legal Business Name | EAST JEFFERSON SLEEP CLINIC, LLC
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Dates
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Enumeration Date | 11/01/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4770 S I 10 SERVICE RD W
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City | METAIRIE
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State | LA
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Zip | 70001-1265
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Country | US
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Telephone | 985-727-0097
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1158
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City | MANDEVILLE
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State | LA
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Zip | 70470-1158
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JAMES BOYLE
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Credential |
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Telephone | 985-727-0097
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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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