=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477014363
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA SAMAD DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2019
-----------------------------------------------------
Last Update Date | 07/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 DAVIS AVE FL 6
-----------------------------------------------------
City | NEPTUNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07753-4488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-897-2770
-----------------------------------------------------
Fax | 732-897-3970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2601 OCEAN PKWY
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11235-7791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-616-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 25MB12661700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------