Provider Demographics
NPI:1518237452
Name:WISTREICH, SARAH J (DO)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:J
Last Name:WISTREICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:LEGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:271 GROVE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1730
Mailing Address - Country:US
Mailing Address - Phone:973-559-3700
Mailing Address - Fax:833-484-1686
Practice Address - Street 1:570 SOUTH AVE E BLDG G UNIT A
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3200
Practice Address - Country:US
Practice Address - Phone:908-272-7990
Practice Address - Fax:833-488-1207
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09128600207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0299073Medicaid
NJ243175Medicare PIN