Basic Information
Provider Information
NPI: 1003139064
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SANDEL
FirstName: PINCHUS
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OPHTHALMIC DISPENSER
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 148 HOOPER ST
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112117902
CountryCode: US
TelephoneNumber: 7188759000
FaxNumber: 7188757331
Practice Location
Address1: 148 HOOPER ST
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112117902
CountryCode: US
TelephoneNumber: 7188759000
FaxNumber: 7188757331
Other Information
ProviderEnumerationDate: 03/05/2010
LastUpdateDate: 03/05/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
156FX1800X007594NYY Eye and Vision Services ProvidersTechnician/TechnologistOptician

No ID Information.


Home