Healthcare Provider Details

I. General information

NPI: 1689378226
Provider Name (Legal Business Name): OGNOMY SLEEP ASSOCIATES, NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 N IRONWOOD RD STE 202
GLENDALE WI
53217-4908
US

IV. Provider business mailing address

640 ELLICOTT ST
BUFFALO NY
14203-1245
US

V. Phone/Fax

Practice location:
  • Phone: 877-664-6669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA GLANZER
Title or Position: CLINICAL OPERATIONS MANAGER
Credential:
Phone: 701-367-4616