Individual
DR. BRUCE SANDEROV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
519 W JERICHO TPKE, SMITHTOWN, NY 11787-2619
(631) 360-5900
(631) 360-9403
Mailing address
519 W JERICHO TPKE, SUITE 204, SMITHTOWN, NY 11787-2619
(631) 360-5900
(631) 360-9403
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
152464-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1115475
—
NY
Enumeration date
07/27/2006
Last updated
08/12/2013
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