Provider Demographics
NPI:1194778795
Name:MIDWAY SLEEP LAB LLC
Entity type:Organization
Organization Name:MIDWAY SLEEP LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHAAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-293-6146
Mailing Address - Street 1:9663 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:323-933-0422
Mailing Address - Fax:323-954-1822
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4667
Practice Address - Country:US
Practice Address - Phone:323-933-0422
Practice Address - Fax:323-954-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG434Medicare ID - Type UnspecifiedPROVIDER NUMBER