MEDICARE: MISS MASSIEL SARMIENTO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	25MA10642600	NJ

General Provider Information

NPI Number	:	1386049633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MASSIEL SARMIENTO MD

Provider Business Mailing Address
First Line	:	2119 ROUTE 88 E
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-3227
Country	:	US
Telephone Number	:	732-899-0008
Fax Number	:

Provider Business Practice Location Address
First Line	:	2119 ROUTE 88 E
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-3227
Country	:	US
Telephone Number	:	732-899-0008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2014
Last Update Date	:	12/18/2019

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