Basic Information
Provider Information
NPI: 1003935651
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SIEMERS
FirstName: SARAH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 972 BRUSH HOLLOW RD
Address2:  
City: WESTBURY
State: NY
PostalCode: 115901740
CountryCode: US
TelephoneNumber: 5168765555
FaxNumber: 5168761246
Practice Location
Address1: 300 COMMUNITY DR
Address2:  
City: MANHASSET
State: NY
PostalCode: 110303816
CountryCode: US
TelephoneNumber: 5165624100
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/28/2007
LastUpdateDate: 10/11/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X340450NYN Nursing Service ProvidersRegistered Nurse 
363L00000XF301095NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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