Provider Demographics
NPI:1407823263
Name:BURGIO, SARA MARIA (CNP)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:MARIA
Last Name:BURGIO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 CAMP RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-2600
Mailing Address - Country:US
Mailing Address - Phone:716-646-1084
Mailing Address - Fax:716-646-0763
Practice Address - Street 1:4855 CAMP RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-2600
Practice Address - Country:US
Practice Address - Phone:716-646-1084
Practice Address - Fax:716-646-0763
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333888-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02429041Medicaid
NYP78476Medicare UPIN
NYDD8988Medicare PIN
NYP00297185Medicare PIN
DD8988Medicare PIN
NY02429041Medicaid
DD8671Medicare PIN