Provider Demographics
NPI:1023182359
Name:ISAACS MOELLER, SANDRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:ISAACS MOELLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:ISAACS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3413 KENWOOD COURT
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-3204
Mailing Address - Country:US
Mailing Address - Phone:609-641-1063
Mailing Address - Fax:
Practice Address - Street 1:705 WHITE HORSE PIKE
Practice Address - Street 2:SUITE S - 5A
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201-1468
Practice Address - Country:US
Practice Address - Phone:609-383-8566
Practice Address - Fax:609-383-8874
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00273500103T00000X
NY0059841103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0485573000OtherAMERIHEALTH
NJ0807508Medicaid
NY653754Medicare ID - Type Unspecified
A32893Medicare UPIN
NJ653754Medicare ID - Type Unspecified