Provider Demographics
NPI:1013256205
Name:BUCKLEY, SARAH MARJORIE (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARJORIE
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 E 55TH ST
Mailing Address - Street 2:APT. 15
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4173
Mailing Address - Country:US
Mailing Address - Phone:703-625-1148
Mailing Address - Fax:
Practice Address - Street 1:630 WEST 168TH STREET, NY PRESB HOSP-CU MEDICAL CENTER
Practice Address - Street 2:MEDICAL INTENSIVE CARE UNIT B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:703-625-1148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY563257-1163WC0200X
NYF430676363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine