MEDICARE: DR. MARVIN SANDERS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	80993	NY

General Provider Information

NPI Number	:	1235574534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARVIN SANDERS M.D.

Provider Business Mailing Address
First Line	:	425 PARK ST
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07043-1920
Country	:	US
Telephone Number	:	718-645-0141
Fax Number	:	718-645-0141

Provider Business Practice Location Address
First Line	:	3947 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2435
Country	:	US
Telephone Number	:	718-645-0141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2013
Last Update Date	:	05/01/2013

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