Provider Demographics
NPI:1720599285
Name:NORTHWELL HEALTH SLEEP LAB LLC
Entity Type:Organization
Organization Name:NORTHWELL HEALTH SLEEP LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:FALGOUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-873-6500
Mailing Address - Street 1:560 NORTHERN BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5113
Mailing Address - Country:US
Mailing Address - Phone:516-873-6500
Mailing Address - Fax:
Practice Address - Street 1:560 NORTHERN BLVD STE 208
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5113
Practice Address - Country:US
Practice Address - Phone:516-873-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic