Provider Demographics
NPI:1770243636
Name:DIACIK, SARA MORGAN
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MORGAN
Last Name:DIACIK
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 1:762 BACKHUS ESTATE RD
Mailing Address - Street 2:
Mailing Address - City:GLEN GARDNER
Mailing Address - State:NJ
Mailing Address - Zip Code:08826-2205
Mailing Address - Country:US
Mailing Address - Phone:908-310-9858
Mailing Address - Fax:
Practice Address - Street 1:2100 WESCOTT DR
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4603
Practice Address - Country:US
Practice Address - Phone:908-237-5420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty