Healthcare Provider Details

I. General information

NPI: 1720091085
Provider Name (Legal Business Name): SANDRA H DEITCH CNM, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 BROAD ST
CLIFTON NJ
07013-1645
US

IV. Provider business mailing address

58 PINE ST
NEW CITY NY
10956-6236
US

V. Phone/Fax

Practice location:
  • Phone: 973-928-2912
  • Fax: 973-928-2915
Mailing address:
  • Phone: 845-638-3948
  • Fax: 845-639-4178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR05729800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME00008000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License NumberF360015
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: