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General NPI Number Information
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NPI Number | 1720091085
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Entity Type | Individual
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Provider Name | SANDRA H DEITCH CNM, NP
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Gender | Female
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 716 BROAD ST
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City | CLIFTON
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State | NJ
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Zip | 07013-1645
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Country | US
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Telephone | 973-928-2912
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Fax | 973-928-2915
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Provider Business Mailing Address
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Address Line | 58 PINE ST
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City | NEW CITY
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State | NY
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Zip | 10956-6236
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Country | US
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Telephone | 845-638-3948
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Fax | 845-639-4178
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR05729800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 25ME00008000
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 364SW0102X
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Taxonomy Name | Women's Health Clinical Nurse Specialist
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License Number | F360015
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License Number State | NY
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