Provider Demographics
NPI:1780990226
Name:SANBORN, KIRSTIN (DO)
Entity type:Individual
Prefix:DR
First Name:KIRSTIN
Middle Name:
Last Name:SANBORN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 TANYARD ROAD
Mailing Address - Street 2:SUITE A100
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080
Mailing Address - Country:US
Mailing Address - Phone:856-566-7010
Mailing Address - Fax:856-566-6961
Practice Address - Street 1:1474 TANYARD ROAD
Practice Address - Street 2:SUITE A100
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080
Practice Address - Country:US
Practice Address - Phone:856-566-7010
Practice Address - Fax:856-566-6961
Is Sole Proprietor?:No
Enumeration Date:2010-08-22
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017150207Q00000X
NJ25MB11829300204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine