Basic Information
Provider Information | |||||||||
NPI: | 1831394527 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SANDLER | ||||||||
FirstName: | REBECCA | ||||||||
MiddleName: | ELLEN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GORDON | ||||||||
OtherFirstName: | REBECCA | ||||||||
OtherMiddleName: | ELLEN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1 DIAMOND HILL RD | ||||||||
Address2: |   | ||||||||
City: | BERKELEY HEIGHTS | ||||||||
State: | NJ | ||||||||
PostalCode: | 079222104 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9082734300 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 6 BRIGHTON RD | ||||||||
Address2: |   | ||||||||
City: | CLIFTON | ||||||||
State: | NJ | ||||||||
PostalCode: | 070121647 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2019678221 | ||||||||
FaxNumber: | 2019670340 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/20/2007 | ||||||||
LastUpdateDate: | 09/24/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/24/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA09128200 | NJ | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RE0101X | 25MA09128200 | NJ | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.