Provider Demographics
NPI:1164887071
Name:SLEEP DYNAMICS
Entity Type:Organization
Organization Name:SLEEP DYNAMICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTSAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-455-3030
Mailing Address - Street 1:2240 STATE ROUTE 33
Mailing Address - Street 2:SUITE 114
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6104
Mailing Address - Country:US
Mailing Address - Phone:732-455-3030
Mailing Address - Fax:
Practice Address - Street 1:2240 STATE ROUTE 33
Practice Address - Street 2:SUITE 114
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753-6104
Practice Address - Country:US
Practice Address - Phone:732-455-3988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05819200207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty