Healthcare Provider Details

I. General information

NPI: 1548265788
Provider Name (Legal Business Name): DAVID JONATHAN SANDS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAVID J SANDS DPM

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 NORTHERN BLVD. SUITE 210
GREAT NECK NY
11021
US

IV. Provider business mailing address

560 NORTHERN BLVD. SUITE 210
GREAT NECK NY
11021
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-8826
  • Fax: 516-482-8828
Mailing address:
  • Phone: 516-482-8826
  • Fax: 516-482-8828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005419
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: