MEDICARE: WELLNESS CENTER FOR SLEEP & DIAGNOSTICS INC

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	:	1366701823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS CENTER FOR SLEEP & DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	8403 CUTHBERT RD
Second Line	:	APT 1A
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2140
Country	:	US
Telephone Number	:	917-957-4489
Fax Number	:	718-441-0554

Provider Business Practice Location Address
First Line	:	8403 CUTHBERT RD
Second Line	:	APT 1A
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2140
Country	:	US
Telephone Number	:	917-957-4489
Fax Number	:	718-441-0554

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERIC HANNA
Credential	:
Telephone Number	:	917-957-4489

Provider Enumeration Date	:	05/03/2012
Last Update Date	:	05/03/2012

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