Healthcare Provider Details

I. General information

NPI: 1164689642
Provider Name (Legal Business Name): SARA M CALVERT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 FOREST AVE
PARAMUS NJ
07652-5241
US

IV. Provider business mailing address

6 FOREST AVE
PARAMUS NJ
07652-5241
US

V. Phone/Fax

Practice location:
  • Phone: 201-587-7850
  • Fax: 201-587-0707
Mailing address:
  • Phone: 201-587-7850
  • Fax: 201-587-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number239467
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMA083927
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: