Provider Demographics
NPI:1881018281
Name:HOM, SARA (MAED)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HOM
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 77TH ST
Mailing Address - Street 2:APT B1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3243
Mailing Address - Country:US
Mailing Address - Phone:347-933-8434
Mailing Address - Fax:
Practice Address - Street 1:408 77TH ST
Practice Address - Street 2:APT B1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3243
Practice Address - Country:US
Practice Address - Phone:347-933-8434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist