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NPI Code Detail

MEDICARE: SARA DEBOER

MEDICARE: SARA DEBOER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1252Y00000XEarly Intervention Provider Agency029815NY
2390200000XStudent in an Organized Health Care Education/Training Program

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11598228082OTHERNYNPI

General Provider Information

NPI Number : 1598228082
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA DEBOER
Provider Business Mailing Address
First Line : 1407 STONY BROOK RD
Second Line :
City : STONY BROOK
State : NY
Zip : 11790-2214
Country : US
Telephone Number : 516-650-0192
Fax Number :
Provider Business Practice Location Address
First Line : 1407 STONY BROOK RD
Second Line :
City : STONY BROOK
State : NY
Zip : 11790-2214
Country : US
Telephone Number : 516-650-0192
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2019
Last Update Date : 03/04/2024

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Directions to “ SARA DEBOER ” Practice Location

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