Provider Demographics
NPI:1386893048
Name:JEFFREY R SANDERSON MD
Entity type:Organization
Organization Name:JEFFREY R SANDERSON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFRERY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-354-2241
Mailing Address - Street 1:4 PARK LN
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-2908
Mailing Address - Country:US
Mailing Address - Phone:860-354-2241
Mailing Address - Fax:860-350-8660
Practice Address - Street 1:4 PARK LN
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2908
Practice Address - Country:US
Practice Address - Phone:860-354-2241
Practice Address - Fax:860-350-8660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty