Provider Demographics
NPI:1083609846
Name:SIERRA, NANCY (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:SIERRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 W GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4918
Mailing Address - Country:US
Mailing Address - Phone:732-212-0060
Mailing Address - Fax:
Practice Address - Street 1:268 DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2011
Practice Address - Country:US
Practice Address - Phone:973-877-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05590000207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ17960OtherUHP NON PAR #
NJ60039170-NON PAROtherHORIZONNJHEALTH
NJ1167901Medicaid
NJP00601224OtherRAILROAD MEDICARE
NJ743722AA7Medicare PIN
NJ743722UWXMedicare PIN
NJ743722UWYMedicare PIN
NJ743722DLEMedicare PIN
NJ743722CLDMedicare PIN
NJ743722XZMMedicare PIN
NJF56166Medicare UPIN
NJ743722DPHMedicare PIN
NJ743722XZ2-PENINSULAMedicare PIN
NJ17960OtherUHP NON PAR #
NJP00601224OtherRAILROAD MEDICARE
NJ743722DPKMedicare PIN