Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 190779 | NY |
NPI | 1043357585 |
---|---|
Provider Name | Dr. Marie V Sanford |
First Address | New York, NY 10014-6743 |
Second Address | New York, NY 10024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 12/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BS4089101 | DEA (01) | NY |