Healthcare Provider Details

I. General information

NPI: 1578503553
Provider Name (Legal Business Name): JEFFREY DAVID SANDLER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 CECIL B MOORE AVE
PHILADELPHIA PA
19121-4025
US

IV. Provider business mailing address

508 SAINT ALBANS RD
HAVERTOWN PA
19083-5605
US

V. Phone/Fax

Practice location:
  • Phone: 215-765-0873
  • Fax: 610-446-6543
Mailing address:
  • Phone: 610-446-6543
  • Fax: 610-446-6543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC-002493-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC-002493-L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberSC-002493-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: