Healthcare Provider Details

I. General information

NPI: 1215027123
Provider Name (Legal Business Name): MRS. SARA DIANE LEVINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 PLAINFIELD AVE SUITE 201
EDISON NJ
08817-2598
US

IV. Provider business mailing address

515 PLAINFIELD AVE SUITE 201
EDISON NJ
08817-2598
US

V. Phone/Fax

Practice location:
  • Phone: 732-777-1940
  • Fax: 732-777-1889
Mailing address:
  • Phone: 732-777-1940
  • Fax: 732-777-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00759300
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: