Healthcare Provider Details

I. General information

NPI: 1285076695
Provider Name (Legal Business Name): SARA BURNBAUM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 WASHINGTON AVE
SUFFERN NY
10901
US

IV. Provider business mailing address

40 ROBERT PITT DR
MONSEY NY
10952-3333
US

V. Phone/Fax

Practice location:
  • Phone: 845-357-4500
  • Fax: 845-357-5039
Mailing address:
  • Phone: 845-352-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3410621
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF341062-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: