1912216573 NPI number — PERSANTE SLEEP CARE, INC.

Table of content: (NPI 1912216573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912216573 NPI number — PERSANTE SLEEP CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERSANTE SLEEP CARE, 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:
6
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:
1912216573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 GAITHER DRIVE STE 124
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT. LAUREL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08054-1715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-753-3779
Provider Business Mailing Address Fax Number:
856-234-5010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE CENTURIAN DRIVE STE: 208
Provider Second Line Business Practice Location Address:
ABBY MEDICAL CENTER
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19713-2137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-753-3779
Provider Business Practice Location Address Fax Number:
856-234-5010
Provider Enumeration Date:
09/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PROBASCO
Authorized Official First Name:
TINA
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCE
Authorized Official Telephone Number:
800-753-3779

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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