Healthcare Provider Details

I. General information

NPI: 1053738807
Provider Name (Legal Business Name): SCOTT SANDERS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N MAIN ST SUITE 3
NEW CITY NY
10956-4021
US

IV. Provider business mailing address

301 N MAIN ST SUITE 3
NEW CITY NY
10956-4021
US

V. Phone/Fax

Practice location:
  • Phone: 845-499-2017
  • Fax: 845-499-2018
Mailing address:
  • Phone: 845-499-2017
  • Fax: 845-499-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number2182761
License Number StateNY

VIII. Authorized Official

Name: DR. SCOTT E SANDERS
Title or Position: CEO
Credential: M.D.
Phone: 845-499-2017