Provider Demographics
NPI:1588659437
Name:KANTOREK, SANDRA (OD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:KANTOREK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6332
Mailing Address - Country:US
Mailing Address - Phone:908-687-3433
Mailing Address - Fax:908-687-0589
Practice Address - Street 1:1485 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6332
Practice Address - Country:US
Practice Address - Phone:908-687-3433
Practice Address - Fax:908-687-0589
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00368600152W00000X
NJTPA 27TO00029600152W00000X
NJ27OM00047500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ410006990OtherPALMETTO GBA-RAILROAD MEDICARE
NJ545317OtherAETNA U.S. HEATHCARE ID
NJ222209011OtherHORIZON BLUE CROSS & BLUE SHIELD OF NJ
NJ6500580OtherGHI PROVIDER ID
NJF09898OtherHEALTH NET ID
NJC7E921OtherEMPIRE BC ID
NJP479247OtherOXFORD HEALTH PLAN ID
NJ334259OtherGREAT-WEST HEALTH ID
NJP479247OtherOXFORD HEALTH PLAN ID
NJ521321Medicare PIN