Healthcare Provider Details

I. General information

NPI: 1003961046
Provider Name (Legal Business Name): SARAH DEVORA KLAGSBRUN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CROSS RIVER RD
KATONAH NY
10536-3549
US

IV. Provider business mailing address

800 CROSS RIVER RD
KATONAH NY
10536-3549
US

V. Phone/Fax

Practice location:
  • Phone: 914-763-8151
  • Fax:
Mailing address:
  • Phone: 914-763-8151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number214957
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: