=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437245495
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SONDRA DANTZIC M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 11/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23 VREELAND ROAD
-----------------------------------------------------
City | FLORHAM PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-440-9758
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 VREELAND RD
-----------------------------------------------------
City | FLORHAM PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07932-1510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician
-----------------------------------------------------
License Number | MD057704L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician
-----------------------------------------------------
License Number | 25MA07503600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------