Healthcare Provider Details

I. General information

NPI: 1851148118
Provider Name (Legal Business Name): GARTH P SANFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7785 N STATE ST
LOWVILLE NY
13367-1297
US

IV. Provider business mailing address

3711 MOOSE RIVER RD
BOONVILLE NY
13309-5324
US

V. Phone/Fax

Practice location:
  • Phone: 315-376-5200
  • Fax: 315-376-9317
Mailing address:
  • Phone: 315-525-0657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number354235
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: