Provider Demographics
NPI:1568571628
Name:SLEEP DISORDER LABORATORY SERVICES, LLC
Entity Type:Organization
Organization Name:SLEEP DISORDER LABORATORY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUZETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BADOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-627-1200
Mailing Address - Street 1:259 N MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1220
Mailing Address - Country:US
Mailing Address - Phone:845-627-1200
Mailing Address - Fax:845-627-5700
Practice Address - Street 1:259 N MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-1220
Practice Address - Country:US
Practice Address - Phone:845-627-1200
Practice Address - Fax:845-627-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0028831227800000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Single Specialty
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY97Z811OtherMEDICARE PTAN