Provider Demographics
NPI:1659568160
Name:COLES MCKEOWN, SARAH ALEXANDRA (LAC)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ALEXANDRA
Last Name:COLES MCKEOWN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:311 BALTIC ST
Mailing Address - Street 2:APT 3E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:718-249-3775
Mailing Address - Fax:
Practice Address - Street 1:19 WEST 21ST ST
Practice Address - Street 2:SUITE 904
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-229-1220
Practice Address - Fax:212-229-1330
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003643171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist