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General NPI Number Information
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NPI Number | 1588659437
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Entity Type | Individual
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Provider Name | SANDRA KANTOREK O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | 1485 MORRIS AVE
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City | UNION
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State | NJ
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Zip | 07083-6332
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Country | US
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Telephone | 908-687-3433
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Fax | 908-687-0589
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Provider Business Mailing Address
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Address Line | 1485 MORRIS AVE
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City | UNION
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State | NJ
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Zip | 07083-6332
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Country | US
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Telephone | 908-687-3433
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Fax | 908-687-0589
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00368600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TPA 27TO00029600
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OM00047500
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License Number State | NJ
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