MEDICARE: MRS. SARA TAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156F00000X	Technician/Technologist
2	103K00000X	Behavior Analyst	1-21-56398	NJ

General Provider Information

NPI Number	:	1194312769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA TAL

Provider Business Mailing Address
First Line	:	708 LAKEVIEW DR
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3018
Country	:	US
Telephone Number	:	908-415-8118
Fax Number	:

Provider Business Practice Location Address
First Line	:	708 LAKEVIEW DR
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3018
Country	:	US
Telephone Number	:	908-415-8118
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2020
Last Update Date	:	12/01/2025

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