Provider Demographics
NPI:1801516075
Name:SADSAD, NIKKI
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:SADSAD
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 1:59 FAWCETT BLVD
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-3401
Mailing Address - Country:US
Mailing Address - Phone:609-994-1952
Mailing Address - Fax:
Practice Address - Street 1:59 FAWCETT BLVD
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-3401
Practice Address - Country:US
Practice Address - Phone:609-994-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01918100208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation