Provider Demographics
NPI:1538681473
Name:MONK, SARA VICTORIA (RD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:VICTORIA
Last Name:MONK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ALGONQUIN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1004
Mailing Address - Country:US
Mailing Address - Phone:201-874-4968
Mailing Address - Fax:
Practice Address - Street 1:25 PINE ST STE 4
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3143
Practice Address - Country:US
Practice Address - Phone:862-309-9859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86086693133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1538681473Medicaid