Provider Demographics
NPI:1891016176
Name:NUTMEG SLEEP LAB
Entity Type:Organization
Organization Name:NUTMEG SLEEP LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:HASAN
Authorized Official - Last Name:YEKTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-528-7161
Mailing Address - Street 1:478 BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2406
Mailing Address - Country:US
Mailing Address - Phone:870-528-7161
Mailing Address - Fax:860-528-7163
Practice Address - Street 1:478 BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2406
Practice Address - Country:US
Practice Address - Phone:870-528-7161
Practice Address - Fax:860-528-7163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic