1629134416 NPI number — DR. DEANNA SANDOR MD

Table of content: DR. DEANNA SANDOR MD (NPI 1629134416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629134416 NPI number — DR. DEANNA SANDOR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDOR
Provider First Name:
DEANNA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1629134416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ROUTE 100 MILLPOND ROAD
Provider Second Line Business Mailing Address:
SUITE 207A
Provider Business Mailing Address City Name:
SOMERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-276-2290
Provider Business Mailing Address Fax Number:
914-276-2341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROUTE 100 MILLPOND ROAD
Provider Second Line Business Practice Location Address:
SUITE 207A
Provider Business Practice Location Address City Name:
SOMERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-276-2290
Provider Business Practice Location Address Fax Number:
914-276-2341
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  098936 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 23922P . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 65B131 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2041537 . This is a "OX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1953701 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4184 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0H2717 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".




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