Provider Demographics
NPI:1578503553
Name:SANDLER, JEFFREY DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVID
Last Name:SANDLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 SAINT ALBANS RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5605
Mailing Address - Country:US
Mailing Address - Phone:610-446-6543
Mailing Address - Fax:610-446-6543
Practice Address - Street 1:2233 CECIL B MOORE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-4025
Practice Address - Country:US
Practice Address - Phone:215-765-0873
Practice Address - Fax:610-446-6543
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-002493-L213E00000X, 213EP1101X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00431158OtherBLUE SHIELD ID
PA0060805000OtherINDEPENDENCE BLUE CROSS
PA0000902603001Medicaid
PA00431158OtherBLUE SHIELD ID
PA0000902603001Medicaid