Provider Demographics
NPI:1083611388
Name:SLEEP DIAGNOSTICS OF NEW JERSEY INC.
Entity Type:Organization
Organization Name:SLEEP DIAGNOSTICS OF NEW JERSEY INC.
Other - Org Name:SLEEP DISORDER CLINICS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-979-6161
Mailing Address - Street 1:2333 MORRIS AVE
Mailing Address - Street 2:SUITE C-103
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5714
Mailing Address - Country:US
Mailing Address - Phone:908-688-3366
Mailing Address - Fax:908-688-8115
Practice Address - Street 1:2333 MORRIS AVE
Practice Address - Street 2:SUITE C-103
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5714
Practice Address - Country:US
Practice Address - Phone:908-688-3366
Practice Address - Fax:908-688-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23133261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083834Medicare UPIN