Basic Information
Provider Information
NPI: 1043473309
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOENIG
FirstName: SANDRA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D,
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 170 CHANGEBRIDGE RD
Address2: SUITE C3
City: MONTVILLE
State: NJ
PostalCode: 070459115
CountryCode: US
TelephoneNumber: 9735755540
FaxNumber: 9735754885
Practice Location
Address1: 170 CHANGEBRIDGE RD
Address2: SUITE C3
City: MONTVILLE
State: NJ
PostalCode: 070459115
CountryCode: US
TelephoneNumber: 9735755540
FaxNumber: 9735754885
Other Information
ProviderEnumerationDate: 07/08/2008
LastUpdateDate: 04/04/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X25MA08832700NJY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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