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General NPI Number Information
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NPI Number | 1134429152
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Entity Type | Individual
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Provider Name | BRUCE TODD SANDERS M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 45 FOSTER RD
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City | HOPEWELL JUNCTION
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State | NY
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Zip | 12533-6123
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Country | US
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Telephone | 845-226-4590
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Fax | 845-226-2465
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Provider Business Mailing Address
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Address Line | 111 CLOCK TOWER CMNS
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City | BREWSTER
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State | NY
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Zip | 10509-4055
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Country | US
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Telephone | 845-592-4915
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 53918
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 259019
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License Number State | NY
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