Healthcare Provider Details

I. General information

NPI: 1457728420
Provider Name (Legal Business Name): SLEEP INSIGHTS MEDICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 JEFFERSON RD STE 110
ROCHESTER NY
14623-3270
US

IV. Provider business mailing address

755 JEFFERSON RD STE 110
ROCHESTER NY
14623-3270
US

V. Phone/Fax

Practice location:
  • Phone: 585-385-6070
  • Fax: 508-437-8430
Mailing address:
  • Phone: 585-385-6070
  • Fax: 585-385-6071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number257520-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number257520-1
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACOB DOMINIK
Title or Position: OWNER
Credential: MD
Phone: 585-385-6070