Provider Demographics
NPI:1619592110
Name:TENZER, SANDRA IRENE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:IRENE
Last Name:TENZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9602 57TH AVE APT 7F
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3427
Mailing Address - Country:US
Mailing Address - Phone:347-300-7435
Mailing Address - Fax:
Practice Address - Street 1:455 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-1314
Practice Address - Country:US
Practice Address - Phone:718-292-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009166152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist