Provider Demographics
NPI:1134761349
Name:SANDERS, RITA (TRICHOLOGIST)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:TRICHOLOGIST
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TRICHOLOGIST
Mailing Address - Street 1:500A JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3458
Mailing Address - Country:US
Mailing Address - Phone:201-309-1200
Mailing Address - Fax:
Practice Address - Street 1:500A JERSEY AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3458
Practice Address - Country:US
Practice Address - Phone:201-309-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1581946224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist