Provider Demographics
NPI:1588643522
Name:SANDOR, JULIE E (MA, CCC)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:E
Last Name:SANDOR
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 CLUB RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2528
Mailing Address - Country:US
Mailing Address - Phone:212-860-4102
Mailing Address - Fax:
Practice Address - Street 1:17 E 97TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6926
Practice Address - Country:US
Practice Address - Phone:212-860-4102
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003793-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist