Provider Demographics
NPI:1528671856
Name:SANDERS, HERMAN JR
Entity type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:
Last Name:SANDERS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 MALCOLM X BLVD APT 4D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3017
Mailing Address - Country:US
Mailing Address - Phone:917-561-5238
Mailing Address - Fax:
Practice Address - Street 1:470 MALCOLM X BLVD APT 4D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-3017
Practice Address - Country:US
Practice Address - Phone:917-561-5238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker