Healthcare Provider Details

I. General information

NPI: 1043741986
Provider Name (Legal Business Name): RACHEL ELISE SARGENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6740 4TH AVE
BROOKLYN NY
11220-5350
US

IV. Provider business mailing address

6740 4TH AVE
BROOKLYN NY
11220-5350
US

V. Phone/Fax

Practice location:
  • Phone: 929-455-2770
  • Fax: 929-455-2748
Mailing address:
  • Phone: 929-455-2770
  • Fax: 929-455-2748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number322640
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number322640
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: