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General NPI Number Information
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NPI Number | 1871798710
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Entity Type | Organization
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Legal Business Name | 55 SANDALWOOD ENTERPRISES INC
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 3400 BAINBRIDGE AVE 3RD FLOOR
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City | BRONX
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State | NY
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Zip | 10467
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Country | US
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Telephone | 718-920-4333
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Fax | 718-547-2907
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Provider Business Mailing Address
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Address Line | 818 E MAIN ST
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City | RIVERHEAD
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State | NY
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Zip | 11901-2563
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Country | US
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Telephone | 631-284-2299
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Fax | 631-284-2305
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Authorized Official
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Title or Position | OWNER
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Name | DAVID G CARR
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Credential |
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Telephone | 631-284-2299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number |
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License Number State | NY
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