Provider Demographics
NPI:1184745192
Name:HACKENSACK SLEEP & PULMONARY CENTER LLC
Entity type:Organization
Organization Name:HACKENSACK SLEEP & PULMONARY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FARIBORZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHTYANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-996-0232
Mailing Address - Street 1:170 PROSPECT AVENUE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1840
Mailing Address - Country:US
Mailing Address - Phone:201-996-0232
Mailing Address - Fax:201-996-0095
Practice Address - Street 1:170 PROSPECT AVE STE 20
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1840
Practice Address - Country:US
Practice Address - Phone:201-996-0232
Practice Address - Fax:201-996-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0117668Medicaid
NJ0117668Medicaid