Provider Demographics
NPI:1336632751
Name:GUARNIERI, SARA ELAINE (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELAINE
Last Name:GUARNIERI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ELAINE
Other - Last Name:KWALWASSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:130 KINDERKAMACK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1931
Mailing Address - Country:US
Mailing Address - Phone:201-488-2660
Mailing Address - Fax:
Practice Address - Street 1:30 PROSPECT AVE RADIOLOGY DEPT
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0220912085R0204X
NJ363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology