Provider Demographics
NPI:1790410496
Name:SANDHU, RUPEINDER
Entity Type:Individual
Prefix:
First Name:RUPEINDER
Middle Name:
Last Name:SANDHU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROOPY
Other - Middle Name:
Other - Last Name:SANDHU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1207 E MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5288
Mailing Address - Country:US
Mailing Address - Phone:607-754-2440
Mailing Address - Fax:607-484-0099
Practice Address - Street 1:1207 E MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5288
Practice Address - Country:US
Practice Address - Phone:607-754-2440
Practice Address - Fax:607-484-0099
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008525-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician