Provider Demographics
NPI:1356398440
Name:PERSANTE SLEEP CARE, INC.
Entity type:Organization
Organization Name:PERSANTE SLEEP CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFANIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-234-0770
Mailing Address - Street 1:130 GAITHER DR
Mailing Address - Street 2:SUITE 124
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1715
Mailing Address - Country:US
Mailing Address - Phone:856-234-0770
Mailing Address - Fax:856-793-4924
Practice Address - Street 1:130 GAITHER DR
Practice Address - Street 2:SUITE 124
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1715
Practice Address - Country:US
Practice Address - Phone:856-234-0770
Practice Address - Fax:856-793-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ023090Medicare ID - Type UnspecifiedSOUTHERN NJ PROVIDER
NJ024905Medicare ID - Type UnspecifiedNORTHERN NJ PROVIDER
PA028599Medicare ID - Type UnspecifiedPA PROVIDER
DEFDS002Medicare ID - Type UnspecifiedDE PROVIDER