Provider Demographics
NPI:1689656225
Name:VOREMBERG, SANDRA R (MD)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:R
Last Name:VOREMBERG
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 1:120 MILLBURN AVE
Mailing Address - Street 2:STE M1
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1942
Mailing Address - Country:US
Mailing Address - Phone:973-218-0707
Mailing Address - Fax:973-218-0177
Practice Address - Street 1:120 MILLBURN AVE
Practice Address - Street 2:STE M1
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1942
Practice Address - Country:US
Practice Address - Phone:973-218-0707
Practice Address - Fax:973-218-0177
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA058174208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6247504Medicaid
NJ6247504Medicaid
G30409Medicare UPIN