Provider Demographics
NPI:1245469196
Name:D'AMATO-OYARZUN, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:D'AMATO-OYARZUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BURTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3511
Mailing Address - Country:US
Mailing Address - Phone:718-873-6570
Mailing Address - Fax:
Practice Address - Street 1:100 REMSEN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4213
Practice Address - Country:US
Practice Address - Phone:718-624-7537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2117213E00000X
NY004831213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01266191Medicaid
NY01266191Medicaid
NY02495Medicare PIN