Provider Demographics
NPI:1679653109
Name:SLEEP LAB OF NORTHEASTERN PA
Entity Type:Organization
Organization Name:SLEEP LAB OF NORTHEASTERN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:WASHO
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT, RRT
Authorized Official - Phone:570-585-6220
Mailing Address - Street 1:231 NORTHERN BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9189
Mailing Address - Country:US
Mailing Address - Phone:570-585-6220
Mailing Address - Fax:570-585-6234
Practice Address - Street 1:231 NORTHERN BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9189
Practice Address - Country:US
Practice Address - Phone:570-585-6220
Practice Address - Fax:570-585-6234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA088321Medicare PIN