Provider Demographics
NPI:1215973177
Name:NAVARRE SLEEP DISORDER GROUP INC
Entity type:Organization
Organization Name:NAVARRE SLEEP DISORDER GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:OPPENHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-648-4622
Mailing Address - Street 1:1200 GRAVESEND NECK RD
Mailing Address - Street 2:APT 3L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4256
Mailing Address - Country:US
Mailing Address - Phone:850-936-4714
Mailing Address - Fax:850-936-4713
Practice Address - Street 1:2053 FOUNTAIN PROFESSIONAL CT
Practice Address - Street 2:SUITE B
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-5105
Practice Address - Country:US
Practice Address - Phone:850-936-4714
Practice Address - Fax:850-936-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV3080OtherBC/BS OF FL
FLV3080OtherBC/BS OF FL