Provider Demographics
NPI:1124228788
Name:SANDAU, ROY LEE (DO)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:LEE
Last Name:SANDAU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 CHAPEL AVE W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2048
Mailing Address - Country:US
Mailing Address - Phone:856-669-6061
Mailing Address - Fax:856-665-8053
Practice Address - Street 1:2201 CHAPEL AVE W
Practice Address - Street 2:STE 100
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2048
Practice Address - Country:US
Practice Address - Phone:856-665-2017
Practice Address - Fax:856-488-6769
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08471200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0199125Medicaid
NJ0199125Medicaid