Provider Demographics
NPI:1225400849
Name:ABDELDIEM, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ABDELDIEM
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 1:1 CARRIAGE CITY PLZ
Mailing Address - Street 2:#1118
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-5181
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 CARRIAGE CITY PLZ
Practice Address - Street 2:#1118
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-5181
Practice Address - Country:US
Practice Address - Phone:646-641-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00382900363A00000X
NY0188941363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant