Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC-002493-L | PA |
Y | 222Z00000X | Podiatrist | SC-002493-L | PA |
N | 213EP1101X | Primary Podiatric Medicine | SC-002493-L | PA |
N | 2081S0010X | Sports Medicine | SC-002493-L | PA |
N | 213ES0000X | Sports Medicine | SC-002493-L | PA |
NPI | 1578503553 |
---|---|
Provider Name | Jeffrey David Sandler |
First Address | Havertown, PA 19083-5605 |
Second Address | Philadelphia, PA 19121-4025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 18/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000902603001 | (05) | PA |
00431158 | BLUE SHIELD ID (01) | PA |
0060805000 | INDEPENDENCE BLUE CROSS (01) | PA |
T30389 | (02) | PA |