Healthcare Provider Details

I. General information

NPI: 1821384892
Provider Name (Legal Business Name): SARA JOHN AMBATT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAMMA JOHN RN

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SADDLE RIVER ROAD
MONSEY NY
10952
US

IV. Provider business mailing address

465 SADDLE RIVER ROAD
MONSEY NY
10952
US

V. Phone/Fax

Practice location:
  • Phone: 845-364-6270
  • Fax:
Mailing address:
  • Phone: 845-364-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number465458-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF336670-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: