Provider Demographics
NPI:1336294941
Name:VAISELBUH, SARAH RIVKAH (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:RIVKAH
Last Name:VAISELBUH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ILSE
Other - Middle Name:
Other - Last Name:MEEUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:48 SCOTLAND HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5837
Mailing Address - Country:US
Mailing Address - Phone:845-425-0887
Mailing Address - Fax:
Practice Address - Street 1:48 SCOTLAND HILL RD
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-5837
Practice Address - Country:US
Practice Address - Phone:845-425-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2344882080P0207X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03136192Medicaid
NY03136192Medicaid