Provider Demographics
NPI:1316126949
Name:SARA L. TARSIS, MD,PLLC
Entity type:Organization
Organization Name:SARA L. TARSIS, MD,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:TARSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-434-5600
Mailing Address - Street 1:1122 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1975
Mailing Address - Country:US
Mailing Address - Phone:718-434-5600
Mailing Address - Fax:718-434-5600
Practice Address - Street 1:1122 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1975
Practice Address - Country:US
Practice Address - Phone:718-434-5600
Practice Address - Fax:718-434-5638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209269174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02090288Medicaid
NY185405OtherONE HEALTH PLAN (PPO)
NY209269-N03OtherHIP
NY2299532OtherGHI
NY2K9871OtherB/C & B/S HMO'S
NY3163532OtherAETNA/USHEALTHCARE(HMO)
NYN82479OtherHEALTHNET
NY7664244OtherAETNA/USHEALTHCARE (PPO)
NYP2807514OtherOXFORD
NY2K9871OtherB/C & B/S HMO'S
NY=========Other1199
NY7664244OtherAETNA/USHEALTHCARE (PPO)
NY=========OtherBEECH STREET
NYN82479OtherHEALTHNET
NYH50108Medicare UPIN
NYWEE591Medicare PIN