Provider Demographics
NPI:1144936972
Name:ISAACSON, SARA R (MS, RDN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:R
Last Name:ISAACSON
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 N CREST PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2976
Mailing Address - Country:US
Mailing Address - Phone:732-556-7574
Mailing Address - Fax:
Practice Address - Street 1:49 N CREST PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2976
Practice Address - Country:US
Practice Address - Phone:732-556-7574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
933764133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered