Healthcare Provider Details

I. General information

NPI: 1124228788
Provider Name (Legal Business Name): ROY LEE SANDAU D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 CHAPEL AVE W STE 100
CHERRY HILL NJ
08002-2048
US

IV. Provider business mailing address

2201 CHAPEL AVE W SUITE 100
CHERRY HILL NJ
08002-2048
US

V. Phone/Fax

Practice location:
  • Phone: 856-665-2017
  • Fax: 856-488-6769
Mailing address:
  • Phone: 856-669-6061
  • Fax: 856-665-8053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MB08471200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: