Basic Information
Provider Information | |||||||||
NPI: | 1063789428 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GREGG | ||||||||
FirstName: | SARA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MONATH | ||||||||
OtherFirstName: | SARA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PT | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 331 TILTON RD | ||||||||
Address2: | STE 7 | ||||||||
City: | NORTHFIELD | ||||||||
State: | NJ | ||||||||
PostalCode: | 082251201 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6315805200 | ||||||||
FaxNumber: | 6315805222 | ||||||||
Practice Location | |||||||||
Address1: | 731 LACEY RD | ||||||||
Address2: |   | ||||||||
City: | FORKED RIVER | ||||||||
State: | NJ | ||||||||
PostalCode: | 087311364 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6092426780 | ||||||||
FaxNumber: | 6092426783 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/29/2011 | ||||||||
LastUpdateDate: | 10/19/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01425700 | NJ | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.