Provider Demographics
NPI:1619972494
Name:SANZ, ENRIQUE J (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:J
Last Name:SANZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CRYSTAL RUN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4057
Mailing Address - Country:US
Mailing Address - Phone:845-703-6999
Mailing Address - Fax:845-703-6297
Practice Address - Street 1:219 BLOOMING GROVE TPKE
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553
Practice Address - Country:US
Practice Address - Phone:845-561-8060
Practice Address - Fax:845-561-8523
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226822208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00789561OtherMEDICARE RAILROAD
NY0754J1Medicare PIN
NY6211060001Medicare NSC
NYA400005311Medicare PIN
NYP00789561OtherMEDICARE RAILROAD
NYI18751Medicare UPIN