Provider Demographics
NPI:1184655425
Name:SANDROCK, DENNIS H
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:H
Last Name:SANDROCK
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DENNIS
Other - Middle Name:H
Other - Last Name:SANDROCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2509 PARK AVENUE SUITE 2A
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080
Mailing Address - Country:US
Mailing Address - Phone:908-753-1800
Mailing Address - Fax:908-753-2620
Practice Address - Street 1:2509 PARK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5300
Practice Address - Country:US
Practice Address - Phone:908-753-1800
Practice Address - Fax:908-753-2620
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2769103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ652988Medicare ID - Type Unspecified