Provider Demographics
NPI:1427218924
Name:SARNICKI, JENNIFER (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SARNICKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 STATE RT 23
Mailing Address - Street 2:SUITE 9
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-1603
Mailing Address - Country:US
Mailing Address - Phone:973-513-9880
Mailing Address - Fax:973-513-9882
Practice Address - Street 1:44 STATE RT 23
Practice Address - Street 2:SUITE 9
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1603
Practice Address - Country:US
Practice Address - Phone:973-513-9880
Practice Address - Fax:973-513-9882
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01127100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT151823Medicare PIN