Provider Demographics
NPI:1598766776
Name:FOREM, SANDRA L (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:L
Last Name:FOREM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:222 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6739
Mailing Address - Country:US
Mailing Address - Phone:212-263-7744
Mailing Address - Fax:212-263-7721
Practice Address - Street 1:222 E 41ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6739
Practice Address - Country:US
Practice Address - Phone:212-263-7744
Practice Address - Fax:212-263-7721
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1424992084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY125234OtherAETNA-US HEALTHCARE
NY133271331OtherVYTRA
NY25860OtherVYTRA
NY133271331OtherUNITED HEALTHCARE
NY133271331OtherBEECH ST/MEDICHOICE
NY133936687OtherUPN ELITE
NY25860OtherMULTIPLWAN
NY133271331OtherPHCS
NY142499OtherHIP
NY5524435OtherCIGNA
NY39D04100OtherBLUE CROSS & BLUE SHIELD
133271331OtherUNITED HEALTHCARE
NY133271331OtherMULTIPLAN
NY0M0091OtherACS/HEALTHNET
133271331OtherUNITED HEALTHCARE
NY133271331OtherVYTRA