Provider Demographics
NPI:1558323196
Name:COUBAROUS, SARETA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:SARETA
Middle Name:MARIE
Last Name:COUBAROUS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 YORK RD STE 400
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2866
Mailing Address - Country:US
Mailing Address - Phone:215-531-0132
Mailing Address - Fax:215-887-3869
Practice Address - Street 1:610 YORK RD STE 400
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2866
Practice Address - Country:US
Practice Address - Phone:215-531-0132
Practice Address - Fax:215-887-3869
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08055900204D00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD136105ZACGOtherMEDICARE
DE136099ZAJOtherMEDICARE