Provider Demographics
NPI:1033295126
Name:SANDERS, GEORGE MASON
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MASON
Last Name:SANDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:M
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1005 FRIENDSHIP LN
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1018
Mailing Address - Country:US
Mailing Address - Phone:856-424-6312
Mailing Address - Fax:856-424-7833
Practice Address - Street 1:1916 MARLTON PIKE E
Practice Address - Street 2:SUITE 4
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2139
Practice Address - Country:US
Practice Address - Phone:856-424-6312
Practice Address - Fax:856-424-7833
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1018103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ520963Medicare ID - Type Unspecified