Provider Demographics
NPI:1962445494
Name:SANCHEZ, SERGIO (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:
Last Name:SANCHEZ
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 1:183 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2934
Mailing Address - Country:US
Mailing Address - Phone:732-846-1900
Mailing Address - Fax:732-294-6069
Practice Address - Street 1:183 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2934
Practice Address - Country:US
Practice Address - Phone:732-846-1900
Practice Address - Fax:732-294-6069
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA45039207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ09411071Medicare ID - Type Unspecified
NJC54922Medicare UPIN