Healthcare Provider Details

I. General information

NPI: 1114985942
Provider Name (Legal Business Name): SANDRA L ESCANDON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 RTE 37 W
TOMS RIVER NJ
08755-8007
US

IV. Provider business mailing address

633 RTE 37 W
TOMS RIVER NJ
08755-8007
US

V. Phone/Fax

Practice location:
  • Phone: 732-240-4787
  • Fax: 732-240-3114
Mailing address:
  • Phone: 732-240-4787
  • Fax: 732-240-3114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA04195700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: