Provider Demographics
NPI:1396838538
Name:SANCHEZ, LAURIE S (MD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:S
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:630 W 246TH ST
Mailing Address - Street 2:APT. 828
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3631
Mailing Address - Country:US
Mailing Address - Phone:917-658-3178
Mailing Address - Fax:
Practice Address - Street 1:150 BERGEN ST
Practice Address - Street 2:UH C318 UMDNJ NEW JERSEY MEDICAL SCHOOL
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-972-5601
Practice Address - Fax:973-972-7429
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2296672085R0202X
NJ25MA084035002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology