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General NPI Number Information
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NPI Number | 1558573758
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Entity Type | Individual
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Provider Name | SARA ELIZABETH TSE PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 71 HAYNES ST PROSPECT MANCHESTER HOSPITAL FBC-NICU
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City | MANCHESTER
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State | CT
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Zip | 06040-4131
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Country | US
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Telephone | 860-647-4735
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Fax |
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Provider Business Mailing Address
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Address Line | 6 HERRICK DR
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City | GLENVILLE
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State | NY
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Zip | 12302-5604
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Country | US
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Telephone | 518-817-1031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00058500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 008083-1
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License Number State | NY
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