Provider Demographics
NPI:1861822751
Name:AKWESASNE SLEEP CENTER LLC
Entity Type:Organization
Organization Name:AKWESASNE SLEEP CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD SLEEP TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:MATTICE
Authorized Official - Suffix:
Authorized Official - Credentials:CRTT
Authorized Official - Phone:518-358-2134
Mailing Address - Street 1:352 ROUTE 37
Mailing Address - Street 2:
Mailing Address - City:HOGANSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13655
Mailing Address - Country:US
Mailing Address - Phone:518-358-2134
Mailing Address - Fax:518-358-2135
Practice Address - Street 1:352 STATE ROUTE 37
Practice Address - Street 2:
Practice Address - City:HOGANSBURG
Practice Address - State:NY
Practice Address - Zip Code:13655-3113
Practice Address - Country:US
Practice Address - Phone:518-358-2134
Practice Address - Fax:518-358-2135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003239261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic