Provider Demographics
NPI:1003431131
Name:INNOVATIVE DURABLE MEDICAL, LLC
Entity Type:Organization
Organization Name:INNOVATIVE DURABLE MEDICAL, LLC
Other - Org Name:INNOVATIVE DURABLE MEDICAL, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-864-1373
Mailing Address - Street 1:16400 NE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4115
Mailing Address - Country:US
Mailing Address - Phone:305-864-1373
Mailing Address - Fax:305-868-3124
Practice Address - Street 1:16400 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4115
Practice Address - Country:US
Practice Address - Phone:305-864-1373
Practice Address - Fax:305-868-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty