Provider Demographics
NPI:1437352416
Name:JEFFREY SANDHAUS, M.D., P.C.
Entity Type:Organization
Organization Name:JEFFREY SANDHAUS, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:COONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-932-3535
Mailing Address - Street 1:3601 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1051
Mailing Address - Country:US
Mailing Address - Phone:718-932-3535
Mailing Address - Fax:718-932-6939
Practice Address - Street 1:3601 31ST AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-1051
Practice Address - Country:US
Practice Address - Phone:718-932-3535
Practice Address - Fax:718-932-6939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17415Medicare ID - Type UnspecifiedGROUP MEDICARE PROVIDER #