Provider Demographics
NPI:1255330395
Name:PRONER, SANFORD
Entity type:Individual
Prefix:
First Name:SANFORD
Middle Name:
Last Name:PRONER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-6042
Mailing Address - Country:US
Mailing Address - Phone:914-237-7300
Mailing Address - Fax:914-237-7301
Practice Address - Street 1:1428 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-6042
Practice Address - Country:US
Practice Address - Phone:914-237-7300
Practice Address - Fax:914-237-7301
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003428-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000596OtherCONNETICARE
NY0254254006OtherCIGNA
NY4287378OtherAETNA (PPO OR MC)
NYOH1795OtherHEALTHNET
NY26722OtherUNITED HEALTHCARE
NY92609OtherAETNA (HMO)
NYWS686OtherOXFORD
NYP35822OtherBLUE CROSS BLUE SHIELD
NY0007656OtherGHI
NY480002271OtherRR MEDICARE
NY480002271OtherRR MEDICARE
NY0254254006OtherCIGNA