Provider Demographics
NPI:1225278641
Name:CHARLESTON NEUROSCIENCE INSTITUTE
Entity Type:Organization
Organization Name:CHARLESTON NEUROSCIENCE INSTITUTE
Other - Org Name:CHARLESTON SLEEP LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:JABLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-216-7144
Mailing Address - Street 1:590 LONE TREE DRIVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:843-216-7144
Mailing Address - Fax:843-216-7145
Practice Address - Street 1:590 LONE TREE DRIVE STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-216-7144
Practice Address - Fax:843-216-7145
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLESTON NEUROSCIENCE INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-25
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4411Medicaid
SC8484Medicare PIN