Provider Demographics
NPI:1922204429
Name:IMMERMAN, SARA (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:IMMERMAN
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 1:95 MADISON AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6092
Mailing Address - Country:US
Mailing Address - Phone:973-644-0808
Mailing Address - Fax:973-644-9270
Practice Address - Street 1:95 MADISON AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6092
Practice Address - Country:US
Practice Address - Phone:973-644-0808
Practice Address - Fax:973-644-9270
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09079100207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology