Provider Demographics
NPI:1518197847
Name:POLY-TECH SLEEP SERVICES LLC
Entity type:Organization
Organization Name:POLY-TECH SLEEP SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRABHAKARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TUMPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-864-6101
Mailing Address - Street 1:1718 WELSH RD
Mailing Address - Street 2:SECOND FLOOR, SUITE C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4213
Mailing Address - Country:US
Mailing Address - Phone:215-676-2334
Mailing Address - Fax:215-676-2366
Practice Address - Street 1:1718 WELSH RD
Practice Address - Street 2:SECOND FLOOR, SUITE C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4213
Practice Address - Country:US
Practice Address - Phone:215-676-2334
Practice Address - Fax:215-676-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432380207RS0012X, 207RB0002X
PAYM005236L261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty