Provider Demographics
NPI:1033539572
Name:OMNISLEEP LLC
Entity Type:Organization
Organization Name:OMNISLEEP LLC
Other - Org Name:OMNICARE ANESTHESIA,PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:718-433-0044
Mailing Address - Street 1:PO BOX 30037
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-0037
Mailing Address - Country:US
Mailing Address - Phone:718-433-0044
Mailing Address - Fax:718-433-4644
Practice Address - Street 1:763- NOSTRAND AVENUE
Practice Address - Street 2:OMNICARE MULTISPLECIALTY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216
Practice Address - Country:US
Practice Address - Phone:718-433-0044
Practice Address - Fax:718-433-4644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMNICARE MULTI SPECIALTY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177953320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID NUMBER