Healthcare Provider Details

I. General information

NPI: 1528478427
Provider Name (Legal Business Name): MICHAEL SARGENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 WESTCHESTER AVE GO3
PURCHASE NY
10577-2518
US

IV. Provider business mailing address

3047 29TH ST APT 30
ASTORIA NY
11102-2561
US

V. Phone/Fax

Practice location:
  • Phone: 914-992-0044
  • Fax: 914-683-0974
Mailing address:
  • Phone: 585-760-4531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: