Provider Demographics
NPI:1982706446
Name:SANDBERG, ALAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:SANDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 LENOX RD
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-4041
Mailing Address - Country:US
Mailing Address - Phone:516-404-0829
Mailing Address - Fax:516-466-7828
Practice Address - Street 1:915 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2529
Practice Address - Country:US
Practice Address - Phone:347-236-3163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158140207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY76617OtherVYTRA SPECIALITY GI
NY03E451OtherBCBS
NY2C8127Medicaid
NY500936OtherUSHC SPECALITY GI
NYAP817OtherOXFORD
NY12423POtherHIP
NY41418OtherVYTRA
NY470563OtherUSHC INTERNAL MED
NYD91782Medicare UPIN
NY2C8127Medicaid