Provider Demographics
NPI:1639385727
Name:NORTHEAST INSOMNIA & SLEEP MEDICINE,PLLC
Entity Type:Organization
Organization Name:NORTHEAST INSOMNIA & SLEEP MEDICINE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABDEL-FADIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:718-761-2950
Mailing Address - Street 1:PO BOX 95000-2140
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2140
Mailing Address - Country:US
Mailing Address - Phone:718-604-4695
Mailing Address - Fax:718-774-0044
Practice Address - Street 1:12510 QUEENS BLVD
Practice Address - Street 2:STE. 2701
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1519
Practice Address - Country:US
Practice Address - Phone:718-761-2950
Practice Address - Fax:718-761-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196563207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Not Answered207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG18656Medicare UPIN