Provider Demographics
NPI:1871659110
Name:CHAN, SARA ANNE (PT, CFMT)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ANNE
Last Name:CHAN
Suffix:
Gender:F
Credentials:PT, CFMT
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:ANNE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, CFMT
Mailing Address - Street 1:35 GARFIELD PLACE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3724
Mailing Address - Country:US
Mailing Address - Phone:201-895-0359
Mailing Address - Fax:833-312-9544
Practice Address - Street 1:555 GOFFLE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-895-0359
Practice Address - Fax:833-312-9544
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA1714000225100000X
NY026599-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ17R01Medicare ID - Type UnspecifiedPROVIDER #