Basic Information
| Provider Information | |||||||||
| NPI: | 1598766776 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOREM | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 222 E 41ST ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100176739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122637744 | ||||||||
| FaxNumber: | 2122637721 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 E 41ST ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100176739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122637744 | ||||||||
| FaxNumber: | 2122637721 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0402X | 142499 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
ID Information
| ID | Type | State | Issuer | Description | 125234 | 01 | NY | AETNA-US HEALTHCARE | OTHER | 133271331 | 01 | NY | VYTRA | OTHER | 25860 | 01 | NY | VYTRA | OTHER | 133271331 | 01 | NY | UNITED HEALTHCARE | OTHER | 133271331 | 01 | NY | BEECH ST/MEDICHOICE | OTHER | 133936687 | 01 | NY | UPN ELITE | OTHER | 25860 | 01 | NY | MULTIPLWAN | OTHER | 133271331 | 01 | NY | PHCS | OTHER | 142499 | 01 | NY | HIP | OTHER | 5524435 | 01 | NY | CIGNA | OTHER | 39D04100 | 01 | NY | BLUE CROSS & BLUE SHIELD | OTHER | 133271331 | 01 | UNITED HEALTHCARE | OTHER | 133271331 | 01 | NY | MULTIPLAN | OTHER | 0M0091 | 01 | NY | ACS/HEALTHNET | OTHER |