Healthcare Provider Details

I. General information

NPI: 1992976237
Provider Name (Legal Business Name): SARAH J EASAW MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 ROUTE 70 STE 31S
LAKEWOOD NJ
08701-5973
US

IV. Provider business mailing address

1255 ROUTE 70 STE 31S
LAKEWOOD NJ
08701-5973
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMA62745
License Number StateNJ

VIII. Authorized Official

Name: SARAH J EASAW
Title or Position: OWNER
Credential: MD
Phone: 732-961-0010