Provider Demographics
NPI:1205219458
Name:POTTSVILLE SLEEP PHYSICIANS LLC
Entity Type:Organization
Organization Name:POTTSVILLE SLEEP PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ZIA
Authorized Official - Middle Name:HUSSAIN
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-222-5032
Mailing Address - Street 1:126 SUNRISE PL
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2898
Mailing Address - Country:US
Mailing Address - Phone:607-222-5032
Mailing Address - Fax:866-546-2496
Practice Address - Street 1:1816 W MARKET ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2002
Practice Address - Country:US
Practice Address - Phone:570-581-8218
Practice Address - Fax:888-383-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454695207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty