Provider Demographics
NPI:1770755639
Name:METROPOLITAN SLEEP AND DIAGNOSTIC TESTING LLC
Entity type:Organization
Organization Name:METROPOLITAN SLEEP AND DIAGNOSTIC TESTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUSSANICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-840-7533
Mailing Address - Street 1:596 ANDERSON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1831
Mailing Address - Country:US
Mailing Address - Phone:201-840-7533
Mailing Address - Fax:201-313-4535
Practice Address - Street 1:596 ANDERSON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1831
Practice Address - Country:US
Practice Address - Phone:201-840-7533
Practice Address - Fax:201-313-4535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207YS0012X
NJ25MA04969400207R00000X
NJ25MB08234500208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty