Healthcare Provider Details

I. General information

NPI: 1730536749
Provider Name (Legal Business Name): BRIAN SANDERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 N BROADWAY STE 220
YONKERS NY
10701-1112
US

IV. Provider business mailing address

660 WHITE PLAINS RD STE 400
TARRYTOWN NY
10591-5107
US

V. Phone/Fax

Practice location:
  • Phone: 914-963-8588
  • Fax: 914-963-6758
Mailing address:
  • Phone: 914-333-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number308367
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: