Healthcare Provider Details

I. General information

NPI: 1922417328
Provider Name (Legal Business Name): SUMMIT SLEEP SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 RIVERSIDE DR
BINGHAMTON NY
13905-4218
US

IV. Provider business mailing address

151 RIVERSIDE DR
BINGHAMTON NY
13905-4218
US

V. Phone/Fax

Practice location:
  • Phone: 607-724-1389
  • Fax:
Mailing address:
  • Phone: 607-724-1389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number038425
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number038425
License Number StateNY

VIII. Authorized Official

Name: DR. ANTHONY PALOMBARO
Title or Position: MEMBER
Credential: DDS
Phone: 607-727-1826