Provider Demographics
NPI:1770557837
Name:SANDBERG, MARC I (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:I
Last Name:SANDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9100 WESCOTT DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4677
Mailing Address - Country:US
Mailing Address - Phone:908-237-5400
Mailing Address - Fax:
Practice Address - Street 1:9100 WESCOTT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4677
Practice Address - Country:US
Practice Address - Phone:908-237-6900
Practice Address - Fax:908-237-6995
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA07135000207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8441006Medicaid
NJ8441006Medicaid
NJ44554Q3NMedicare ID - Type Unspecified