Provider Demographics
NPI:1093019333
Name:GRASMERE SLEEP LAB CORP
Entity Type:Organization
Organization Name:GRASMERE SLEEP LAB CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FOUAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-442-2221
Mailing Address - Street 1:PO BOX 120278
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-0278
Mailing Address - Country:US
Mailing Address - Phone:718-442-2221
Mailing Address - Fax:718-966-1199
Practice Address - Street 1:2071 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1671
Practice Address - Country:US
Practice Address - Phone:718-442-2221
Practice Address - Fax:718-966-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty