Provider Demographics
NPI:1306003959
Name:SLEEP AMERICA MEDICAL PC
Entity Type:Organization
Organization Name:SLEEP AMERICA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SONI
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAHBHAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-645-6434
Mailing Address - Street 1:1911 RICHMOND AVE
Mailing Address - Street 2:STE N2ND
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3913
Mailing Address - Country:US
Mailing Address - Phone:718-645-6434
Mailing Address - Fax:718-382-5252
Practice Address - Street 1:1911 RICHMOND AVE
Practice Address - Street 2:STE N2ND
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3913
Practice Address - Country:US
Practice Address - Phone:718-645-6434
Practice Address - Fax:718-382-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192569261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02236428Medicaid
NY02236428Medicaid
NY742181Medicare PIN