Provider Demographics
NPI:1417840463
Name:FACTORA, SAGE NICOLETTE
Entity type:Individual
Prefix:
First Name:SAGE
Middle Name:NICOLETTE
Last Name:FACTORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 TUDOR CITY PL APT 1510
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-7610
Mailing Address - Country:US
Mailing Address - Phone:203-450-7892
Mailing Address - Fax:
Practice Address - Street 1:2212 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3535
Practice Address - Country:US
Practice Address - Phone:212-988-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program