Provider Demographics
NPI:1467524355
Name:SANDRA VAUSE, M.D., P.C.
Entity type:Organization
Organization Name:SANDRA VAUSE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-678-9600
Mailing Address - Street 1:545 BECKETT RD STE 210
Mailing Address - Street 2:PURELAND COMMONS
Mailing Address - City:LOGAN TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1547
Mailing Address - Country:US
Mailing Address - Phone:856-241-3311
Mailing Address - Fax:856-241-3969
Practice Address - Street 1:545 BECKETT RD STE 210
Practice Address - Street 2:PURELAND COMMONS
Practice Address - City:LOGAN TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1547
Practice Address - Country:US
Practice Address - Phone:856-241-3311
Practice Address - Fax:856-241-3969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00136500207N00000X
NJMA059140207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ36062Medicare UPIN
NJ088064Medicare ID - Type Unspecified
NJF05283Medicare UPIN