Provider Demographics
NPI:1962921841
Name:DAN V SANDRU MD LLC
Entity type:Organization
Organization Name:DAN V SANDRU MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:SANDRU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-330-7463
Mailing Address - Street 1:511 HARTSHORNE CT
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8214
Mailing Address - Country:US
Mailing Address - Phone:908-330-7463
Mailing Address - Fax:
Practice Address - Street 1:389 N COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4426
Practice Address - Country:US
Practice Address - Phone:908-330-7463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00741600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA08439200OtherMEDICAL LICENSE