Healthcare Provider Details

I. General information

NPI: 1265424253
Provider Name (Legal Business Name): SARAH J EASAW MD LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 ROUTE 70 31 S
LAKEWOOD NJ
08701-5900
US

IV. Provider business mailing address

1255 ROUTE 70 31 S
LAKEWOOD NJ
08701-5900
US

V. Phone/Fax

Practice location:
  • Phone: 732-961-0010
  • Fax: 732-961-0013
Mailing address:
  • Phone: 732-961-0010
  • Fax: 732-961-0013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06274500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number25MA06274500
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMA62745
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: