Provider Demographics
NPI:1174907091
Name:WATSON, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 CHICKASAW TRL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9703
Mailing Address - Country:US
Mailing Address - Phone:609-304-6709
Mailing Address - Fax:
Practice Address - Street 1:126 E TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08008-3065
Practice Address - Country:US
Practice Address - Phone:732-978-4856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program