Provider Demographics
NPI:1457384166
Name:GRUNDFEST, SANDRA (EDD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:GRUNDFEST
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 EWING ST
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540
Mailing Address - Country:US
Mailing Address - Phone:609-921-8401
Mailing Address - Fax:609-921-9430
Practice Address - Street 1:601 EWING ST
Practice Address - Street 2:SUITE C-1
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-921-8401
Practice Address - Fax:609-921-9430
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00285500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ735885Medicare ID - Type Unspecified