1588659437 NPI number — DR. SANDRA KANTOREK O.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588659437 NPI number — DR. SANDRA KANTOREK O.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KANTOREK

Provider First Name:

SANDRA

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

O.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1588659437

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/29/2009

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1485 MORRIS AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

UNION

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

07083-6332

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

908-687-3433

Provider Business Mailing Address Fax Number:

908-687-0589

Provider First Line Business Practice Location Address:

1485 MORRIS AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

UNION

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

07083-6332

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

908-687-3433

Provider Business Practice Location Address Fax Number:

908-687-0589

Provider Enumeration Date:

09/16/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 152W00000X , with the licence number:  27OA00368600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 152W00000X , with the licence number: TPA 27TO00029600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 152W00000X , with the licence number: 27OM00047500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 410006990 . This is a "PALMETTO GBA-RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 545317 . This is a "AETNA U.S. HEATHCARE ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 222209011 . This is a "HORIZON BLUE CROSS & BLUE SHIELD OF NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 6500580 . This is a "GHI PROVIDER ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: F09898 . This is a "HEALTH NET ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: C7E921 . This is a "EMPIRE BC ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: P479247 . This is a "OXFORD HEALTH PLAN ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 334259 . This is a "GREAT-WEST HEALTH ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".