1265424253 NPI number — SARAH J EASAW MD LLC

Table of content: SARAH J EASAW MD LLC (NPI 1265424253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265424253 NPI number — SARAH J EASAW MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EASAW
Provider First Name:
SARAH
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD LLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265424253
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1255 ROUTE 70
Provider Second Line Business Mailing Address:
31 S
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08701-5900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-961-0010
Provider Business Mailing Address Fax Number:
732-961-0013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1255 ROUTE 70
Provider Second Line Business Practice Location Address:
31 S
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08701-5900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-961-0010
Provider Business Practice Location Address Fax Number:
732-961-0013
Provider Enumeration Date:
08/17/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  25MA06274500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0000X , with the licence number: 25MA06274500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: MA62745 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2223293 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 221900628 . This is a "UNITED HEALTHCARE CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P1112299 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".