Provider Demographics
NPI:1821365099
Name:SLEEP & NEUROLOGICAL DIAGNOSTIC CENTER LLC
Entity Type:Organization
Organization Name:SLEEP & NEUROLOGICAL DIAGNOSTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAFIQ
Authorized Official - Middle Name:UR
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-474-5599
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-0100
Mailing Address - Country:US
Mailing Address - Phone:570-208-5530
Mailing Address - Fax:570-208-5548
Practice Address - Street 1:20 S MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-1123
Practice Address - Country:US
Practice Address - Phone:570-474-5599
Practice Address - Fax:570-474-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty