Provider Demographics
NPI:1033165956
Name:MYRNA SANCHEZ
Entity Type:Organization
Organization Name:MYRNA SANCHEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-483-0482
Mailing Address - Street 1:183 PARK ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1238
Mailing Address - Country:US
Mailing Address - Phone:518-483-0482
Mailing Address - Fax:518-483-6727
Practice Address - Street 1:183 PARK ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1238
Practice Address - Country:US
Practice Address - Phone:518-483-0482
Practice Address - Fax:518-483-6727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184388174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01421618Medicaid
NY01421618Medicaid