Healthcare Provider Details

I. General information

NPI: 1477014363
Provider Name (Legal Business Name): SARA SAMAD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DAVIS AVE FL 6
NEPTUNE NJ
07753-4488
US

IV. Provider business mailing address

2601 OCEAN PKWY
BROOKLYN NY
11235-7791
US

V. Phone/Fax

Practice location:
  • Phone: 732-897-2770
  • Fax: 732-897-3970
Mailing address:
  • Phone: 718-616-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MB12661700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: