Provider Demographics
NPI:1326041021
Name:ZEVON, SANFORD S (MD)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:S
Last Name:ZEVON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2901
Mailing Address - Country:US
Mailing Address - Phone:914-681-3110
Mailing Address - Fax:914-682-6403
Practice Address - Street 1:33 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1030
Practice Address - Country:US
Practice Address - Phone:914-948-3630
Practice Address - Fax:914-946-0926
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY82781174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
B08350Medicare UPIN
160301Medicare ID - Type Unspecified