Provider Demographics
NPI:1194077198
Name:RHODE ISLAND SLEEP DIAGNOSTICS
Entity type:Organization
Organization Name:RHODE ISLAND SLEEP DIAGNOSTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MATARESE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-732-1508
Mailing Address - Street 1:215 TOLL GATE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4462
Mailing Address - Country:US
Mailing Address - Phone:401-732-1508
Mailing Address - Fax:401-732-1592
Practice Address - Street 1:215 TOLL GATE RD STE 301
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4462
Practice Address - Country:US
Practice Address - Phone:401-732-1508
Practice Address - Fax:401-732-1592
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHEN L. MATARESE DO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-15
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO 00355207RS0012X, 332BX2000X
RIDO 0355332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & SuppliesGroup - Single Specialty