Basic Information
| Provider Information | |||||||||
| NPI: | 1932615002 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELLAVITA | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | MICHELE | ||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | HARDER | ||||||||
| OtherFirstName: | SARA | ||||||||
| OtherMiddleName: | MICHELE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 28 KINGSLEY RD | ||||||||
| Address2: | |||||||||
| City: | RINGWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074562214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012486293 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 30 PROSPECT AVE | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076011915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5519962000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2017 | ||||||||
| LastUpdateDate: | 12/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 26NJ00783200 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.