MEDICARE: SUPREME SLEEP 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	207QS1201X	Sleep Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1770448490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPREME SLEEP LLC

Provider Business Mailing Address
First Line	:	155 WILLOWBROOK BLVD STE 110
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 WILLOWBROOK BLVD
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7032
Country	:	US
Telephone Number	:	609-736-0090
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	NEOLA GUSHWAY-HENRY
Credential	:
Telephone Number	:	609-736-0090

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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Directions to “SUPREME SLEEP LLC ” Practice Location

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