MEDICARE: DR. SANDRA L. FOREM M.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	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	142499	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	125234	OTHER	NY	AETNA-US HEALTHCARE
2	133271331	OTHER	NY	VYTRA
3	25860	OTHER	NY	VYTRA
4	133271331	OTHER	NY	UNITED HEALTHCARE
5	133271331	OTHER	NY	BEECH ST/MEDICHOICE
6	133936687	OTHER	NY	UPN ELITE
7	25860	OTHER	NY	MULTIPLWAN
8	133271331	OTHER	NY	PHCS
9	142499	OTHER	NY	HIP
10	5524435	OTHER	NY	CIGNA
11	39D04100	OTHER	NY	BLUE CROSS & BLUE SHIELD
12	133271331	OTHER		UNITED HEALTHCARE
13	133271331	OTHER	NY	MULTIPLAN
14	0M0091	OTHER	NY	ACS/HEALTHNET

General Provider Information

NPI Number	:	1598766776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA L. FOREM M.D.

Provider Business Mailing Address
First Line	:	222 E 41ST ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-6739
Country	:	US
Telephone Number	:	212-263-7744
Fax Number	:	212-263-7721

Provider Business Practice Location Address
First Line	:	222 E 41ST ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-6739
Country	:	US
Telephone Number	:	212-263-7744
Fax Number	:	212-263-7721

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	03/31/2021

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