Provider Demographics
NPI:1609431212
Name:SALL SLEEP MEDICINE PLLC
Entity Type:Organization
Organization Name:SALL SLEEP MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:SALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-436-4366
Mailing Address - Street 1:4000 MEDICAL CENTER DR STE 404
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-6631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4000 MEDICAL CENTER DR STE 404
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6631
Practice Address - Country:US
Practice Address - Phone:315-671-8796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Single Specialty