Basic Information
| Provider Information | |||||||||
| NPI: | 1225488034 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILLETTE | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | |||||||||
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| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | NULL | ||||||||
| OtherFirstName: | SARAH | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 44 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | LITTLE FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133651433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155426083 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 140 BURWELL ST | ||||||||
| Address2: | |||||||||
| City: | LITTLE FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133651725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158231000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2016 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 340671 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.