MEDICARE: PHILADELPHIA SLEEP CENTER 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	293D00000X	Physiological Laboratory	6000007207	PA

General Provider Information

NPI Number	:	1891174157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILADELPHIA SLEEP CENTER INC.

Provider Business Mailing Address
First Line	:	2324 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-4417
Country	:	US
Telephone Number	:	215-952-0752
Fax Number	:	215-952-0963

Provider Business Practice Location Address
First Line	:	2324 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-4417
Country	:	US
Telephone Number	:	215-952-0752
Fax Number	:	215-952-0963

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH CAVUTO
Credential	:	D.O.
Telephone Number	:	215-952-0752

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	05/20/2015

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