Healthcare Provider Details

I. General information

NPI: 1013256205
Provider Name (Legal Business Name): SARAH MARJORIE BUCKLEY ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 WEST 168TH STREET, NY PRESB HOSP-CU MEDICAL CENTER MEDICAL INTENSIVE CARE UNIT B
NEW YORK NY
10032
US

IV. Provider business mailing address

334 E 55TH ST APT. 15
NEW YORK NY
10022-4173
US

V. Phone/Fax

Practice location:
  • Phone: 703-625-1148
  • Fax:
Mailing address:
  • Phone: 703-625-1148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number563257-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF430676
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: