MEDICARE: CARDIO SLEEP DENTAL SOLUTIONS 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	332BC3200X	Customized Equipment (DME)
2	122300000X	Dentist	DI20783	NJ

General Provider Information

NPI Number	:	1841513918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIO SLEEP DENTAL SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	30 ROUTE 18 N
Second Line	:
City	:	OLD BRIDGE
State	:	NJ
Zip	:	08857-1420
Country	:	US
Telephone Number	:	732-254-5999
Fax Number	:	732-257-5606

Provider Business Practice Location Address
First Line	:	593 CRANBURY RD
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-4029
Country	:	US
Telephone Number	:	732-254-5999
Fax Number	:	732-257-5606

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AVI WEISFOGEL
Credential	:	DDS
Telephone Number	:	732-254-5999

Provider Enumeration Date	:	03/03/2010
Last Update Date	:	04/11/2011

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