Provider Demographics
NPI:1255458105
Name:SANDHU, BALDEV SINGH (M,D,)
Entity type:Individual
Prefix:DR
First Name:BALDEV
Middle Name:SINGH
Last Name:SANDHU
Suffix:
Gender:M
Credentials:M,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-1828
Mailing Address - Country:US
Mailing Address - Phone:201-337-6286
Mailing Address - Fax:
Practice Address - Street 1:600 E PALISADE AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-1828
Practice Address - Country:US
Practice Address - Phone:201-337-6286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05286200208200000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD91863Medicare UPIN
NJ630733Medicare ID - Type Unspecified