Provider Demographics
NPI:1376938944
Name:EDERY, SARAH
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:EDERY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:EDERY-ALTAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2854 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4014
Mailing Address - Country:US
Mailing Address - Phone:201-792-2582
Mailing Address - Fax:
Practice Address - Street 1:2854 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4014
Practice Address - Country:US
Practice Address - Phone:201-792-2582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01587200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist