Provider Demographics
NPI:1497172696
Name:SANDOUKAS, GEORGE (LMT, NCBTMB, MMP)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:SANDOUKAS
Suffix:
Gender:M
Credentials:LMT, NCBTMB, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 BRANDON AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1301
Mailing Address - Country:US
Mailing Address - Phone:646-853-2853
Mailing Address - Fax:
Practice Address - Street 1:47 BRANDON AVE.
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:646-853-2853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00405400225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist