Provider Demographics
NPI:1770011504
Name:DANA, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:DANA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:GOTTESMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6631 WETHEROLE ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4640
Mailing Address - Country:US
Mailing Address - Phone:347-330-1921
Mailing Address - Fax:
Practice Address - Street 1:8866 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7857
Practice Address - Country:US
Practice Address - Phone:718-850-0400
Practice Address - Fax:718-850-4441
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program