Provider Demographics
NPI:1689790339
Name:SALL MYERS ASSOCIATES, PA
Entity Type:Organization
Organization Name:SALL MYERS ASSOCIATES, PA
Other - Org Name:SALL MYERS MEDICAL ASSOCIATES, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MINASSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-278-7065
Mailing Address - Street 1:PO BOX 2947
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07509-2947
Mailing Address - Country:US
Mailing Address - Phone:973-279-2323
Mailing Address - Fax:973-279-4773
Practice Address - Street 1:100 HAMILTON PLZ
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-2109
Practice Address - Country:US
Practice Address - Phone:973-279-2323
Practice Address - Fax:973-279-4773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22367261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty