Provider Demographics
NPI:1619135902
Name:SECOND HOME SLEEP LAB INC
Entity Type:Organization
Organization Name:SECOND HOME SLEEP LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-645-6434
Mailing Address - Street 1:1911 RICHMOND AVE
Mailing Address - Street 2:SUITE210, 2ND FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:718-494-7769
Mailing Address - Fax:718-494-7767
Practice Address - Street 1:1911 RICHMOND AVE STE 2102ND
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3913
Practice Address - Country:US
Practice Address - Phone:718-494-7769
Practice Address - Fax:718-494-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic