Provider Demographics
NPI:1114524121
Name:ENDY, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ENDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63A 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5056
Mailing Address - Country:US
Mailing Address - Phone:201-541-8600
Mailing Address - Fax:201-541-8100
Practice Address - Street 1:63A 8TH ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5056
Practice Address - Country:US
Practice Address - Phone:201-541-8600
Practice Address - Fax:201-541-8100
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1821392473Medicaid