Provider Demographics
NPI:1457619611
Name:NEW ENGLAND SLEEP THERAPY, LLC
Entity Type:Organization
Organization Name:NEW ENGLAND SLEEP THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIGON
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-369-6918
Mailing Address - Street 1:1291 BOSTON POST RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-3476
Mailing Address - Country:US
Mailing Address - Phone:203-815-0385
Mailing Address - Fax:
Practice Address - Street 1:1291 BOSTON POST RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3476
Practice Address - Country:US
Practice Address - Phone:203-815-0385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Multi-Specialty