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General NPI Number Information
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NPI Number | 1518787894
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Entity Type | Individual
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Provider Name | SARAH ELIZABETH SIESSEL
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Gender | Female
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 16 POCONO RD STE 112
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City | DENVILLE
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State | NJ
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Zip | 07834-2905
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Country | US
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Telephone | 973-627-3765
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Fax |
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Provider Business Mailing Address
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Address Line | 1322 WOOD VALLEY RD
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City | MOUNTAINSIDE
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State | NJ
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Zip | 07092-1854
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Country | US
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Telephone | 973-714-3194
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15176400
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License Number State | NJ
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