Provider Demographics
NPI:1083941454
Name:ATLANTIC SLEEP AND PULMONARY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ATLANTIC SLEEP AND PULMONARY ASSOCIATES, LLC
Other - Org Name:SLEEPWELL CENTERS OF NJ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-822-2772
Mailing Address - Street 1:300 MADISON AVE
Mailing Address - Street 2:SUITE LL103
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1868
Mailing Address - Country:US
Mailing Address - Phone:973-822-1772
Mailing Address - Fax:973-822-1779
Practice Address - Street 1:300 MADISON AVE
Practice Address - Street 2:SUITE LL103
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1868
Practice Address - Country:US
Practice Address - Phone:973-822-0075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05147800261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE73397Medicare UPIN