Healthcare Provider Details

I. General information

NPI: 1366174237
Provider Name (Legal Business Name): SARAH AYVAZOV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 E LAUREL RD
STRATFORD NJ
08084-1327
US

IV. Provider business mailing address

18 E LAUREL RD
STRATFORD NJ
08084-1327
US

V. Phone/Fax

Practice location:
  • Phone: 856-346-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103301464
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: