1295870871 NPI number — COASTAL SLEEP DIAGNOSTICS INC.

Table of content: (NPI 1295870871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295870871 NPI number — COASTAL SLEEP DIAGNOSTICS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL 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:
1295870871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 BLACKSTONE VALLEY PL STE 707
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02865-1170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-286-9201
Provider Business Mailing Address Fax Number:
781-740-9156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76 AIRLINE RD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH DENNIS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02660-2583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-740-9155
Provider Business Practice Location Address Fax Number:
781-740-9156
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PRENDA
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/COO
Authorized Official Telephone Number:
781-740-9155

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS1200X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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