Provider Demographics
NPI:1548265788
Name:SANDS, DAVID JONATHAN (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JONATHAN
Last Name:SANDS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:J
Other - Last Name:SANDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:560 NORTHERN BLVD.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-482-8826
Mailing Address - Fax:516-482-8828
Practice Address - Street 1:560 NORTHERN BLVD.
Practice Address - Street 2:SUITE 210
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-482-8826
Practice Address - Fax:516-482-8828
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005419213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07892GOtherGHI MEDICARE
NY01978005Medicaid
NYPEWA21OtherEMPIRE MEDICARE
P00417949OtherRAILROAD MEDICARE
P00417949OtherRAILROAD MEDICARE