MEDICARE: NOCTURNAL SLEEP DIAGNOSTICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1346566601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOCTURNAL SLEEP DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	9320 ROOSEVELT AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7944
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9320 ROOSEVELT AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7944
Country	:	US
Telephone Number	:	718-791-9649
Fax Number	:

Authorized Official
Title or Position	:	MANAGER / MEMBER
Name	:	AURELIO HENRIQUEZ
Credential	:
Telephone Number	:	718-971-9649

Provider Enumeration Date	:	04/12/2010
Last Update Date	:	04/12/2010

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