Provider Demographics
NPI:1053012203
Name:VAN DINA, SARAH JOAN
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JOAN
Last Name:VAN DINA
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 1:81 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4461
Mailing Address - Country:US
Mailing Address - Phone:347-986-9827
Mailing Address - Fax:
Practice Address - Street 1:44 COURT ST STE 1217
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4410
Practice Address - Country:US
Practice Address - Phone:347-970-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency