Provider Demographics
NPI:1487780706
Name:SOUTH JERSEY SLEEP DISORDERS CENTER, LLC
Entity type:Organization
Organization Name:SOUTH JERSEY SLEEP DISORDERS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KENNEDY-LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-413-1043
Mailing Address - Street 1:120 W NEW JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-2764
Mailing Address - Country:US
Mailing Address - Phone:609-413-1043
Mailing Address - Fax:609-492-4798
Practice Address - Street 1:120 W NEW JERSEY AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08008-2764
Practice Address - Country:US
Practice Address - Phone:609-413-1043
Practice Address - Fax:609-492-4798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07337300207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH21620Medicare UPIN
NJ078114Medicare ID - Type UnspecifiedDAWN M KENNEDY-LITTLE, DO