Provider Demographics
NPI:1689671141
Name:MEYERSFIELD, SANFORD A (MD)
Entity Type:Individual
Prefix:
First Name:SANFORD
Middle Name:A
Last Name:MEYERSFIELD
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 1:2001 MARCUS AVE
Mailing Address - Street 2:SUITE N-214
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1011
Mailing Address - Country:US
Mailing Address - Phone:516-437-4228
Mailing Address - Fax:516-355-0637
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:SUITE N-214
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-1011
Practice Address - Country:US
Practice Address - Phone:516-437-4228
Practice Address - Fax:516-355-0637
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117122208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00335951Medicaid
NYB12776Medicare UPIN
NY314211Medicare ID - Type Unspecified