Provider Demographics
NPI:1376785634
Name:SANDAR, NAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NAN
Middle Name:
Last Name:SANDAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4039
Mailing Address - Country:US
Mailing Address - Phone:718-821-0643
Mailing Address - Fax:718-628-4123
Practice Address - Street 1:129 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4039
Practice Address - Country:US
Practice Address - Phone:718-821-0643
Practice Address - Fax:718-628-4123
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252447-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI44636Medicare UPIN