Provider Demographics
NPI:1992174858
Name:WEINMANN, SARAH DIANNE (PA)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:DIANNE
Last Name:WEINMANN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:DIANNE
Other - Last Name:HEADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7205 COVENTRY CT
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-1636
Mailing Address - Country:US
Mailing Address - Phone:413-426-2570
Mailing Address - Fax:
Practice Address - Street 1:214 STATE ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5500
Practice Address - Country:US
Practice Address - Phone:201-342-7662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5483363AM0700X
NJ25MP00421100363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical