Provider Demographics
NPI:1336768647
Name:SARKER, ABUL (PA)
Entity Type:Individual
Prefix:
First Name:ABUL
Middle Name:
Last Name:SARKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:DR
Other - First Name:ABUL
Other - Middle Name:
Other - Last Name:SARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:2 SAGAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-7412
Mailing Address - Country:US
Mailing Address - Phone:718-309-0656
Mailing Address - Fax:845-357-1832
Practice Address - Street 1:2 SAGAMORE AVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-7412
Practice Address - Country:US
Practice Address - Phone:718-309-0656
Practice Address - Fax:845-357-1832
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYO000218363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical