Provider Demographics
NPI:1912421918
Name:TWIN COUNTY SLEEP CENTER LLC
Entity Type:Organization
Organization Name:TWIN COUNTY SLEEP CENTER LLC
Other - Org Name:TWIN COUNTY SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-965-8956
Mailing Address - Street 1:46 QUAIL LN
Mailing Address - Street 2:
Mailing Address - City:TIVOLI
Mailing Address - State:NY
Mailing Address - Zip Code:12583-5007
Mailing Address - Country:US
Mailing Address - Phone:518-965-8956
Mailing Address - Fax:
Practice Address - Street 1:TWIN COUNTY SLEEP CENTER, 2 SHERMAN POTTS DR
Practice Address - Street 2:STE 201
Practice Address - City:GHENT
Practice Address - State:NY
Practice Address - Zip Code:12075-3216
Practice Address - Country:US
Practice Address - Phone:518-633-4464
Practice Address - Fax:518-633-4469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197319207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01648246Medicaid