Provider Demographics
NPI:1003359787
Name:ROBERT SANDER,MD
Entity Type:Organization
Organization Name:ROBERT SANDER,MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-584-8092
Mailing Address - Street 1:477 ROUTE 10 E STE 205
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2144
Mailing Address - Country:US
Mailing Address - Phone:973-584-8092
Mailing Address - Fax:973-584-5586
Practice Address - Street 1:477 ROUTE 10 E STE 205
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2144
Practice Address - Country:US
Practice Address - Phone:973-584-8092
Practice Address - Fax:973-584-5586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06942700261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9014101Medicaid
NJ050353Medicare PIN