Provider Demographics
NPI:1477508661
Name:WERT, SANFORD R (MD)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:R
Last Name:WERT
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 1:3075 BRIGHTON 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5607
Mailing Address - Country:US
Mailing Address - Phone:718-332-4747
Mailing Address - Fax:718-332-0414
Practice Address - Street 1:3075 BRIGHTON 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5607
Practice Address - Country:US
Practice Address - Phone:718-332-4747
Practice Address - Fax:718-332-0414
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128807174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00406657Medicaid
NY00406657Medicaid
NY10A841Medicare ID - Type UnspecifiedMEDICARE