1497817175 NPI number — MRS. SANDRA ILYA DRESDNER MSW

Table of content: MRS. SANDRA ILYA DRESDNER MSW (NPI 1497817175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497817175 NPI number — MRS. SANDRA ILYA DRESDNER MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRESDNER
Provider First Name:
SANDRA
Provider Middle Name:
ILYA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SERBIN
Provider Other First Name:
SANDRA
Provider Other Middle Name:
ILYA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497817175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 LEXINGTON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATHAM
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07928-2906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-635-5779
Provider Business Mailing Address Fax Number:
973-635-5779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 LEXINGTON CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATHAM
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07928-2906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-635-5779
Provider Business Practice Location Address Fax Number:
973-635-5779
Provider Enumeration Date:
12/15/2006

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: 1041C0700X , with the licence number:  44SC00005400 , 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)

  • Identifier: NJ LIC. # 44SC000054 . This is a "LICENSE NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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