1861822751 NPI number — AKWESASNE SLEEP CENTER LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861822751 NPI number — AKWESASNE SLEEP CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AKWESASNE SLEEP CENTER LLC
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:
1861822751
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
352 ROUTE 37
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOGANSBURG
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-358-2134
Provider Business Mailing Address Fax Number:
518-358-2135

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
352 STATE ROUTE 37
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOGANSBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13655-3113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-358-2134
Provider Business Practice Location Address Fax Number:
518-358-2135
Provider Enumeration Date:
11/14/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MATTICE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
ERNEST
Authorized Official Title or Position:
LEAD SLEEP TECHNICIAN
Authorized Official Telephone Number:
518-358-2134

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  003239 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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