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General NPI Number Information
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NPI Number | 1609431212
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Entity Type | Organization
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Legal Business Name | SALL SLEEP MEDICINE PLLC
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 4000 MEDICAL CENTER DR STE 404
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-6631
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Country | US
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Telephone | 315-671-8796
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 MEDICAL CENTER DR STE 404
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-6631
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWARD T SALL
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Credential | MD
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Telephone | 315-436-4366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0012X
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Taxonomy Name | Sleep Medicine (Otolaryngology) Physician
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License Number |
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License Number State |
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