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NPI Code Detail

MEDICARE: SANDRA L SQUIRES MD

MEDICARE: SANDRA L SQUIRES MD
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
12084P0800XPsychiatry PhysicianMAO58291NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720057946
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA L SQUIRES MD
Provider Business Mailing Address
First Line : 175 HIGH ST
Second Line : 40 PARK PLACE
City : NEWTON
State : NJ
Zip : 07860-1004
Country : US
Telephone Number : 973-579-8975
Fax Number : 973-579-8423
Provider Business Practice Location Address
First Line : 175 HIGH ST
Second Line :
City : NEWTON
State : NJ
Zip : 07860-1004
Country : US
Telephone Number : 973-579-8975
Fax Number : 973-579-8423
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2006
Last Update Date : 08/04/2010

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