Healthcare Provider Details

I. General information

NPI: 1841706751
Provider Name (Legal Business Name): TRI COUNTY SLEEP SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 N MAIN ST
CANANDAIGUA NY
14424-1442
US

IV. Provider business mailing address

344 N MAIN ST
CANANDAIGUA NY
14424-1030
US

V. Phone/Fax

Practice location:
  • Phone: 718-812-2869
  • Fax: 718-812-2869
Mailing address:
  • Phone: 718-812-2869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number374944
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number374944
License Number StateNY

VIII. Authorized Official

Name: DR. GERMAIN JEAN-CHARLES
Title or Position: PRESIDENT
Credential:
Phone: 585-394-4746