Provider Demographics
NPI:1730239724
Name:SANDERS, ELISSA MERYL (MD)
Entity type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:MERYL
Last Name:SANDERS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:172 SUMMIT AVENUE
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1817
Mailing Address - Country:US
Mailing Address - Phone:973-509-3399
Mailing Address - Fax:973-509-3388
Practice Address - Street 1:112 WEST 80TH STREET
Practice Address - Street 2:SUITE 1F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6329
Practice Address - Country:US
Practice Address - Phone:212-579-4655
Practice Address - Fax:973-509-3388
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY1684172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E87261Medicare UPIN