Provider Demographics
NPI:1194858027
Name:VERMONT MEDICAL SLEEP DISORDERS CENTER INC
Entity Type:Organization
Organization Name:VERMONT MEDICAL SLEEP DISORDERS CENTER INC
Other - Org Name:ADIRONDACK REGIONAL SLEEP DISORDERS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:PAQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:802-878-4445
Mailing Address - Street 1:139 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3659
Mailing Address - Country:US
Mailing Address - Phone:802-878-4445
Mailing Address - Fax:802-878-4607
Practice Address - Street 1:142 BOYNTON AVE
Practice Address - Street 2:STE B
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1292
Practice Address - Country:US
Practice Address - Phone:518-561-4500
Practice Address - Fax:518-561-4532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY470001703OtherPALMETTO GBA
NY470001703OtherPALMETTO GBA