Provider Demographics
NPI:1063503332
Name:SLEEP DIAGNOSTICS CENTER LLC
Entity Type:Organization
Organization Name:SLEEP DIAGNOSTICS CENTER LLC
Other - Org Name:THE SLEEP DISORDER CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:POTELUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-237-0349
Mailing Address - Street 1:1000 MEADE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-3197
Mailing Address - Country:US
Mailing Address - Phone:570-342-0800
Mailing Address - Fax:570-969-1200
Practice Address - Street 1:1000 MEADE ST STE 202
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-3197
Practice Address - Country:US
Practice Address - Phone:570-342-0800
Practice Address - Fax:570-969-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA083756Medicare Oscar/Certification