Provider Demographics
NPI:1740570860
Name:BITTMAN, SARA CUCCIO (MD)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:CUCCIO
Last Name:BITTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:GAYLE
Other - Last Name:CUCCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:79 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-7926
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3705 HARLENE DR
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3938
Practice Address - Country:US
Practice Address - Phone:917-969-1637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1740570860207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program