Provider Demographics
NPI:1902839509
Name:GUALTIERI, SARA LILIANA (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LILIANA
Last Name:GUALTIERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WEXFORD LN
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1383
Mailing Address - Country:US
Mailing Address - Phone:609-927-6989
Mailing Address - Fax:
Practice Address - Street 1:1 WEXFORD LN
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1383
Practice Address - Country:US
Practice Address - Phone:609-927-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07665600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I01581Medicare UPIN
029794Medicare ID - Type UnspecifiedGROUP
076774Medicare ID - Type Unspecified