Healthcare Provider Details

I. General information

NPI: 1740794569
Provider Name (Legal Business Name): SLEEP APNEA TREATMENT CENTRE OF AMERICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 12/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W TAFT RD STE 4N
LIVERPOOL NY
13088-3807
US

IV. Provider business mailing address

5068 PINE VALLEY DR
FAYETTEVILLE NY
13066-9723
US

V. Phone/Fax

Practice location:
  • Phone: 315-458-8844
  • Fax:
Mailing address:
  • Phone: 315-882-5042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number048823
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number048823
License Number StateNY

VIII. Authorized Official

Name: DR. BRENT A BRADFORD
Title or Position: PRESIDENT
Credential: DDS
Phone: 315-882-5042