Healthcare Provider Details

I. General information

NPI: 1619888252
Provider Name (Legal Business Name): TAYLOR SARGIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 SPRINGFIELD AVE STE 201-202
SUMMIT NJ
07901-2622
US

IV. Provider business mailing address

467 SPRINGFIELD AVE STE 201-202
SUMMIT NJ
07901-2622
US

V. Phone/Fax

Practice location:
  • Phone: 917-510-4317
  • Fax:
Mailing address:
  • Phone: 917-510-4317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07419400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: