Healthcare Provider Details

I. General information

NPI: 1336294941
Provider Name (Legal Business Name): SARAH RIVKAH VAISELBUH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ILSE MEEUS MD

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 SCOTLAND HILL RD
CHESTNUT RIDGE NY
10977-5837
US

IV. Provider business mailing address

48 SCOTLAND HILL RD
CHESTNUT RIDGE NY
10977-5837
US

V. Phone/Fax

Practice location:
  • Phone: 845-425-0887
  • Fax:
Mailing address:
  • Phone: 845-425-0887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number234488
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number234488
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: