Healthcare Provider Details

I. General information

NPI: 1518006675
Provider Name (Legal Business Name): KATHLEEN ANN SARADARIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 WANTAGE AVE UNIT 3
BRANCHVILLE NJ
07826-5640
US

IV. Provider business mailing address

PO BOX 2457 (22 WANTAGE AVE., UNIT 3)
BRANCHVILLE NJ
07826-2457
US

V. Phone/Fax

Practice location:
  • Phone: 973-948-4232
  • Fax: 973-948-6712
Mailing address:
  • Phone: 973-948-4232
  • Fax: 973-948-6712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA05277900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: