Healthcare Provider Details

I. General information

NPI: 1255458105
Provider Name (Legal Business Name): BALDEV SINGH SANDHU M,D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E PALISADE AVE
ENGLEWOOD CLIFFS NJ
07632-1828
US

IV. Provider business mailing address

600 E PALISADE AVE
ENGLEWOOD CLIFFS NJ
07632-1828
US

V. Phone/Fax

Practice location:
  • Phone: 201-337-6286
  • Fax:
Mailing address:
  • Phone: 201-337-6286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number25MA05286200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number25MA05286200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: