Provider Demographics
NPI:1992014559
Name:CARDIO SLEEP SOLUTIONS PENNSYLVANIA LLC
Entity type:Organization
Organization Name:CARDIO SLEEP SOLUTIONS PENNSYLVANIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVI
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISFOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-254-5999
Mailing Address - Street 1:30 ROUTE 18 N
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1420
Mailing Address - Country:US
Mailing Address - Phone:732-254-5999
Mailing Address - Fax:732-257-5606
Practice Address - Street 1:217 HARRISBURG AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2964
Practice Address - Country:US
Practice Address - Phone:732-254-5999
Practice Address - Fax:732-257-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
PA332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6480400001Medicare NSC