Healthcare Provider Details

I. General information

NPI: 1699400564
Provider Name (Legal Business Name): BRIDGET MM SARICH LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2022
Last Update Date: 07/23/2022
Certification Date: 07/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 WIGGINS AVE
PATCHOGUE NY
11772-3811
US

IV. Provider business mailing address

8 WIGGINS AVE
PATCHOGUE NY
11772-3811
US

V. Phone/Fax

Practice location:
  • Phone: 631-848-8394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number304834
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: