Provider Demographics
NPI:1588121644
Name:SARTIN, MAFATIMA (PHLEBOTOMY TECHNICIA)
Entity type:Individual
Prefix:
First Name:MAFATIMA
Middle Name:
Last Name:SARTIN
Suffix:
Gender:F
Credentials:PHLEBOTOMY TECHNICIA
Other - Prefix:
Other - First Name:INDIA
Other - Middle Name:
Other - Last Name:SARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2139 ROBIN LN
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-3621
Mailing Address - Country:US
Mailing Address - Phone:732-814-0214
Mailing Address - Fax:
Practice Address - Street 1:2139 ROBIN LN
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-3621
Practice Address - Country:US
Practice Address - Phone:732-814-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL25308265156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0000Medicaid