Provider Demographics
NPI:1811592900
Name:YOURMAN, SARAH R (RDN, CDCES)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:R
Last Name:YOURMAN
Suffix:
Gender:F
Credentials:RDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-1111
Mailing Address - Country:US
Mailing Address - Phone:201-696-7692
Mailing Address - Fax:201-791-1241
Practice Address - Street 1:30 PROSPECT AVE FL WFAN3
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1915
Practice Address - Country:US
Practice Address - Phone:551-996-5329
Practice Address - Fax:551-996-0115
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
IL860595942080P0206X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology