Provider Demographics
NPI:1780622399
Name:SARES, ELEAZAR A (PT)
Entity type:Individual
Prefix:
First Name:ELEAZAR
Middle Name:A
Last Name:SARES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 ROUTE 34
Mailing Address - Street 2:PARK PLAZA MALL
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-9514
Mailing Address - Country:US
Mailing Address - Phone:732-290-2299
Mailing Address - Fax:
Practice Address - Street 1:343 ROUTE 34
Practice Address - Street 2:PARK PLAZA MALL
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-9514
Practice Address - Country:US
Practice Address - Phone:732-290-2299
Practice Address - Fax:732-290-1616
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40AQ01134700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ098305Medicare ID - Type Unspecified