Provider Demographics
NPI:1629134416
Name:SANDOR, DEANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:
Last Name:SANDOR
Suffix:
Gender:F
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:ROUTE 100 MILLPOND ROAD
Mailing Address - Street 2:SUITE 207A
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589
Mailing Address - Country:US
Mailing Address - Phone:914-276-2290
Mailing Address - Fax:914-276-2341
Practice Address - Street 1:ROUTE 100 MILLPOND ROAD
Practice Address - Street 2:SUITE 207A
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589
Practice Address - Country:US
Practice Address - Phone:914-276-2290
Practice Address - Fax:914-276-2341
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098936207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
23922POtherHIP
65B131OtherBCBS
P2041537OtherOX
1953701OtherUNITED
4184OtherGHI
0H2717OtherHEALTHNET
1953701OtherUNITED
23922POtherHIP