Provider Demographics
NPI:1992981989
Name:PHILADELPHIA SLEEP CENTER, INC.
Entity type:Organization
Organization Name:PHILADELPHIA SLEEP CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BROTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-788-2700
Mailing Address - Street 1:2701 BARTRAM RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-6810
Mailing Address - Country:US
Mailing Address - Phone:215-788-2709
Mailing Address - Fax:215-788-2716
Practice Address - Street 1:2701 BARTRAM RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-6810
Practice Address - Country:US
Practice Address - Phone:215-788-2709
Practice Address - Fax:215-788-2716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
124082Medicare PIN