Provider Demographics
NPI:1154630671
Name:SANDOMIR, DONNA ELISE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:ELISE
Last Name:SANDOMIR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2663 BOUNDARY LN
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-4722
Mailing Address - Country:US
Mailing Address - Phone:516-826-0386
Mailing Address - Fax:
Practice Address - Street 1:56 CATHEDRAL AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2819
Practice Address - Country:US
Practice Address - Phone:516-294-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009634-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor