| Organization Name: | 55 SANDALWOOD ENTERPRISES INC |
| NPI Number: | 1083691539 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PHYLLIS ZENKER (GENERAL MANAGER) |
| Mailing Address: | 3400 Bainbridge Ave Greene Medical Arts Pavilion 3rd Floor Bronx |
| State: | NY US |
| Postal Code: | 104672404 |
| Phone Number: | 7189204333 |
| Fax Number: | 6314477939 |
| NPI Enumeration Date: | 12/27/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 15000010884 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |