Healthcare Provider Details

I. General information

NPI: 1437245495
Provider Name (Legal Business Name): SONDRA DANTZIC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 VREELAND ROAD
FLORHAM PARK NJ
07932
US

IV. Provider business mailing address

23 VREELAND RD
FLORHAM PARK NJ
07932-1510
US

V. Phone/Fax

Practice location:
  • Phone: 732-440-9758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License NumberMD057704L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number25MA07503600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: