Provider Demographics
NPI:1386715787
Name:SANCOR MEDICAL ENTERPRISES LLC
Entity type:Organization
Organization Name:SANCOR MEDICAL ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-890-0037
Mailing Address - Street 1:100 MYLES STANDISH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-7321
Mailing Address - Country:US
Mailing Address - Phone:508-880-3700
Mailing Address - Fax:508-880-2093
Practice Address - Street 1:3219 E TREMONT AVE
Practice Address - Street 2:LL2
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5751
Practice Address - Country:US
Practice Address - Phone:718-892-6351
Practice Address - Fax:718-892-6350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWZYRV1Medicare PIN