1316126949 NPI number — SARA L. TARSIS, MD,PLLC

Table of content: (NPI 1316126949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316126949 NPI number — SARA L. TARSIS, MD,PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SARA L. TARSIS, MD,PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316126949
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1122 OCEAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11230-1975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-434-5600
Provider Business Mailing Address Fax Number:
718-434-5600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1122 OCEAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230-1975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-434-5600
Provider Business Practice Location Address Fax Number:
718-434-5638
Provider Enumeration Date:
10/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TARSIS
Authorized Official First Name:
SARA
Authorized Official Middle Name:
LEAH
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
718-434-5600

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  209269 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02090288 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 185405 . This is a "ONE HEALTH PLAN (PPO)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 209269-N03 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2299532 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2K9871 . This is a "B/C & B/S HMO'S" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3163532 . This is a "AETNA/USHEALTHCARE(HMO)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N82479 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7664244 . This is a "AETNA/USHEALTHCARE (PPO)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2807514 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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