MEDICARE: SARAH NIELSEN 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	208000000X	Pediatrics Physician	25MA07887200	NJ

General Provider Information

NPI Number	:	1811081409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH NIELSEN MD

Provider Business Mailing Address
First Line	:	PO BOX 95000 LB#7550
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19195-7550
Country	:	US
Telephone Number	:	844-362-1735
Fax Number	:	973-290-7495

Provider Business Practice Location Address
First Line	:	799 BLOOMFIELD AVE STE 304
Second Line	:
City	:	VERONA
State	:	NJ
Zip	:	07044-1301
Country	:	US
Telephone Number	:	973-618-9990
Fax Number	:	973-618-9991

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	04/08/2022

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