Healthcare Provider Details

I. General information

NPI: 1225450851
Provider Name (Legal Business Name): SAGAR S LAD PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STATE HIGHWAY 33 SUITE 9-10
NEPTUNE NJ
07753-6102
US

IV. Provider business mailing address

2100 STATE HIGHWAY 33 SUITE 9-10
NEPTUNE NJ
07753-6102
US

V. Phone/Fax

Practice location:
  • Phone: 732-988-3441
  • Fax: 732-988-7123
Mailing address:
  • Phone: 732-988-3441
  • Fax: 732-988-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5925
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: