Provider Demographics
NPI:1982796462
Name:MACCORKINDALE, SARA A (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:A
Last Name:MACCORKINDALE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HAMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-7224
Mailing Address - Country:US
Mailing Address - Phone:516-809-6900
Mailing Address - Fax:
Practice Address - Street 1:176 N VILLAGE AVE
Practice Address - Street 2:SUITE 2D
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3800
Practice Address - Country:US
Practice Address - Phone:516-764-2115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY500831367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR1C80ZT5H1Medicare PIN
NY0650AYMedicare PIN
NYR1C80ZXWW1Medicare PIN
NYR1C801Medicare PIN
NYR1C80YRXP1Medicare PIN
NYR1C8034881Medicare PIN