Healthcare Provider Details

I. General information

NPI: 1386715787
Provider Name (Legal Business Name): SANCOR MEDICAL ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219 E TREMONT AVE LL2
BRONX NY
10461-5751
US

IV. Provider business mailing address

100 MYLES STANDISH BLVD
TAUNTON MA
02780-7321
US

V. Phone/Fax

Practice location:
  • Phone: 718-892-6351
  • Fax: 718-892-6350
Mailing address:
  • Phone: 508-880-3700
  • Fax: 508-880-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. COREY WEINER
Title or Position: PRESIDENT
Credential:
Phone: 973-890-0037