Healthcare Provider Details

I. General information

NPI: 1063569739
Provider Name (Legal Business Name): RITA ILUMINADA SANCHEZ MD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 02/08/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MERITORIA DR
EAST WILLISTON NY
11596-2037
US

IV. Provider business mailing address

3 MERITORIA DR
EAST WILLISTON NY
11596-2037
US

V. Phone/Fax

Practice location:
  • Phone: 516-508-1351
  • Fax:
Mailing address:
  • Phone: 516-508-1351
  • Fax: 516-307-3396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number233996-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number233996-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: