Healthcare Provider Details

I. General information

NPI: 1457101156
Provider Name (Legal Business Name): DANIEL SANCHEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE MAIN BUILDING, 3RD FLOOR, ROOM 3672
HACKENSACK NJ
07601
US

IV. Provider business mailing address

30 PROSPECT AVE MAIN BUILDING, 3RD FLOOR, ROOM 3672
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2331
  • Fax: 551-996-0937
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: