Provider Demographics
NPI:1760641799
Name:SARRA, LORRAINE V
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:V
Last Name:SARRA
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 1:72 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2216
Mailing Address - Country:US
Mailing Address - Phone:908-722-3622
Mailing Address - Fax:908-526-3957
Practice Address - Street 1:72 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2216
Practice Address - Country:US
Practice Address - Phone:908-722-3622
Practice Address - Fax:908-526-3957
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNONE175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22971782OtherEMPLOYER ID NUMBER