=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508474255
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH KAREN ANN APPLEGATE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2020
-----------------------------------------------------
Last Update Date | 07/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 AIRPORT RD
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-6924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 160-984-7482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 228 W 3RD ST APT 1
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08518-1919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-336-6969
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------