Provider Demographics
NPI:1992976237
Name:SARAH J EASAW MD LLC
Entity type:Organization
Organization Name:SARAH J EASAW MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:EASAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-961-0010
Mailing Address - Street 1:1255 ROUTE 70 STE 31S
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5973
Mailing Address - Country:US
Mailing Address - Phone:732-961-0010
Mailing Address - Fax:
Practice Address - Street 1:1255 ROUTE 70 STE 31S
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5973
Practice Address - Country:US
Practice Address - Phone:732-961-0010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62745207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF22155Medicare UPIN
NJ800451VCMMedicare PIN