1841506904 NPI number — DR. SARAH ANNE LACARRUBBA D.O.

Table of content: DR. SARAH ANNE LACARRUBBA D.O. (NPI 1841506904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841506904 NPI number — DR. SARAH ANNE LACARRUBBA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LACARRUBBA
Provider First Name:
SARAH
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAZURKEVICH
Provider Other First Name:
SARAH
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841506904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1345 RXR PLZ FL 13
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIONDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11556-1301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-453-0435
Provider Business Mailing Address Fax Number:
646-846-3283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 W 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10011-7524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-703-0991
Provider Business Practice Location Address Fax Number:
212-390-0906
Provider Enumeration Date:
08/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  268992 , 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)





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