Provider Demographics
NPI:1053738807
Name:SCOTT SANDERS MD PLLC
Entity type:Organization
Organization Name:SCOTT SANDERS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-499-2017
Mailing Address - Street 1:301 N MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4021
Mailing Address - Country:US
Mailing Address - Phone:845-499-2017
Mailing Address - Fax:845-499-2018
Practice Address - Street 1:301 N MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4021
Practice Address - Country:US
Practice Address - Phone:845-499-2017
Practice Address - Fax:845-499-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2182761207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty