1417170853 NPI number — SANDI TOBIN LCSW

Table of content: (NPI 1417170853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417170853 NPI number — SANDI TOBIN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDI TOBIN LCSW
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1417170853
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9094
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARAMUS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07653-9094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-527-0351
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 ROUTE 17 NORTH
Provider Second Line Business Practice Location Address:
SUITE 313
Provider Business Practice Location Address City Name:
PARAMUS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-527-0351
Provider Business Practice Location Address Fax Number:
914-682-3755
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TOBIN
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
201-527-0351

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC04716600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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