MEDICARE: DR. SANDRA KANTOREK O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	27OA00368600	NJ
2	152W00000X	Optometrist	TPA 27TO00029600	NJ
3	152W00000X	Optometrist	27OM00047500	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410006990	OTHER	NJ	PALMETTO GBA-RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	545317	OTHER	NJ	AETNA U.S. HEATHCARE ID
3	222209011	OTHER	NJ	HORIZON BLUE CROSS & BLUE SHIELD OF NJ
4	6500580	OTHER	NJ	GHI PROVIDER ID
5	F09898	OTHER	NJ	HEALTH NET ID
6	C7E921	OTHER	NJ	EMPIRE BC ID
7	P479247	OTHER	NJ	OXFORD HEALTH PLAN ID
8	334259	OTHER	NJ	GREAT-WEST HEALTH ID

General Provider Information

NPI Number	:	1588659437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA KANTOREK O.D.

Provider Business Mailing Address
First Line	:	1485 MORRIS AVE
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-6332
Country	:	US
Telephone Number	:	908-687-3433
Fax Number	:	908-687-0589

Provider Business Practice Location Address
First Line	:	1485 MORRIS AVE
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-6332
Country	:	US
Telephone Number	:	908-687-3433
Fax Number	:	908-687-0589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	09/29/2009

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