Provider Demographics
NPI:1568726453
Name:STATE, SARA C (MS)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:C
Last Name:STATE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4921
Mailing Address - Country:US
Mailing Address - Phone:718-871-4893
Mailing Address - Fax:
Practice Address - Street 1:1257 38TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1928
Practice Address - Country:US
Practice Address - Phone:718-516-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist