1003853540 NPI number — DELMARVA SLEEP DIAGNOSTICS, INC.

Table of content: (NPI 1003853540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003853540 NPI number — DELMARVA SLEEP DIAGNOSTICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELMARVA SLEEP DIAGNOSTICS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003853540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 SLEEPY HOLLOW DR
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19709-8894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-449-5460
Provider Business Mailing Address Fax Number:
302-449-5475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 SLEEPY HOLLOW DR
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19709-8894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-449-5460
Provider Business Practice Location Address Fax Number:
302-449-5475
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GODLEWSKI
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
302-449-5460

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  2004206616 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3096779 . This is a "CIGNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: P00227885 . This is a "PALMETTO GBA NORTH REGION" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1000034930 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3843471 . This is a "AETNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: A3619429 . This is a "OXFORD HEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 268237 . This is a "COVENTRY" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2133502 . This is a "MAMSI" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0000826401 . This is a "DELAWARE PHYSICIANS CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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