Healthcare Provider Details

I. General information

NPI: 1528001260
Provider Name (Legal Business Name): DAVID SANCHEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W SUFFOLK AVE SUITE 200
CENTRAL ISLIP NY
11722-2156
US

IV. Provider business mailing address

45 W SUFFOLK AVE SUITE 200
CENTRAL ISLIP NY
11722-2143
US

V. Phone/Fax

Practice location:
  • Phone: 631-582-2228
  • Fax: 631-582-4881
Mailing address:
  • Phone: 631-582-2228
  • Fax: 631-582-4881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number215692
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: