1982706446 NPI number — DR. ALAN R SANDBERG MD

Table of content: DR. ALAN R SANDBERG MD (NPI 1982706446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982706446 NPI number — DR. ALAN R SANDBERG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDBERG
Provider First Name:
ALAN
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1982706446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
162 LENOX RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BABYLON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11704-4041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-404-0829
Provider Business Mailing Address Fax Number:
516-466-7828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 HILLSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11040-2529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-236-3163
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/03/2006

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: 207RI0008X , with the licence number:  158140 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 158140 , 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: 76617 . This is a "VYTRA SPECIALITY GI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 03E451 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2C8127 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500936 . This is a "USHC SPECALITY GI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AP817 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 12423P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 41418 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 470563 . This is a "USHC INTERNAL MED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com