MEDICARE: SLEEP & BREATHING DISORDERS CENTER, 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	:	1548496235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP & BREATHING DISORDERS CENTER, LLC

Provider Business Mailing Address
First Line	:	2792 OCEAN AVE
Second Line	:	UNIT 5
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4708
Country	:	US
Telephone Number	:	718-975-0640
Fax Number	:

Provider Business Practice Location Address
First Line	:	2792 OCEAN AVE
Second Line	:	UNIT 5
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4708
Country	:	US
Telephone Number	:	718-975-0640
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAVEL TELYATNIKOV
Credential	:	RPSGT
Telephone Number	:	718-902-3133

Provider Enumeration Date	:	06/08/2009
Last Update Date	:	03/20/2012

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