MEDICARE: SLEEP PRO 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	122300000X	Dentist

General Provider Information

NPI Number	:	1699212886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP PRO LLC

Provider Business Mailing Address
First Line	:	9601 PULASKI PARK DRIVE
Second Line	:	SUITE 416
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-1409
Country	:	US
Telephone Number	:	410-933-5678
Fax Number	:	410-238-7451

Provider Business Practice Location Address
First Line	:	901 EASTERN BOULEVARD
Second Line	:	SUITE 200
City	:	ESSEX
State	:	MD
Zip	:	21221-3416
Country	:	US
Telephone Number	:	410-682-5500
Fax Number	:	410-686-3803

Authorized Official
Title or Position	:	PARTNER
Name	:	LAWRENCE L RUBIN
Credential	:	M.D.
Telephone Number	:	410-933-5678

Provider Enumeration Date	:	01/25/2017
Last Update Date	:	01/26/2017

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Directions to “SLEEP PRO LLC ” Practice Location

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