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General NPI Number Information
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NPI Number | 1730239724
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Entity Type | Individual
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Provider Name | ELISSA MERYL SANDERS MD
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 112 WEST 80TH STREET SUITE 1F
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City | NEW YORK
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State | NY
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Zip | 10024-6329
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Country | US
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Telephone | 212-579-4655
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Fax | 973-509-3388
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Provider Business Mailing Address
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Address Line | 172 SUMMIT AVENUE
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City | UPPER MONTCLAIR
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State | NJ
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Zip | 07043-1817
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Country | US
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Telephone | 973-509-3399
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Fax | 973-509-3388
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 168417
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License Number State | NY
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