Provider Demographics
NPI:1700221207
Name:HOWARD, SAGE ALEXANDRA
Entity Type:Individual
Prefix:
First Name:SAGE
Middle Name:ALEXANDRA
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 VERNON AVE
Mailing Address - Street 2:#1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-6409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 VERNON AVE
Practice Address - Street 2:#1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-6409
Practice Address - Country:US
Practice Address - Phone:831-566-9187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1282324174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist