Healthcare Provider Details

I. General information

NPI: 1780670927
Provider Name (Legal Business Name): SCOTT SANDERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 02/18/2016
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 Number218276
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: