Provider Demographics
NPI: | 1912059577 |
---|---|
Name: | NEWARK OPERATING COMPANY LLC |
Entity Type: | Organization |
Organization Name: | NEWARK OPERATING COMPANY LLC |
Other - Org Name: | AMERICAN SLEEP MEDICINE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SHAPOURI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 443-254-4161 |
Mailing Address - Street 1: | 200 CONTINENTAL DR STE 122 |
Mailing Address - Street 2: | |
Mailing Address - City: | NEWARK |
Mailing Address - State: | DE |
Mailing Address - Zip Code: | 19713-4303 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 302-366-0111 |
Mailing Address - Fax: | 302-366-0110 |
Practice Address - Street 1: | 200 CONTINENTAL DRIVE |
Practice Address - Street 2: | SUITE 112 |
Practice Address - City: | NEWARK |
Practice Address - State: | DE |
Practice Address - Zip Code: | 19713-4369 |
Practice Address - Country: | US |
Practice Address - Phone: | 302-366-0111 |
Practice Address - Fax: | 302-366-0110 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-16 |
Last Update Date: | 2023-09-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QS1200X | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |