Basic Information
| Provider Information | |||||||||
| NPI: | 1497149835 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRONIN | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 245 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK MILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134171257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153715280 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1729 BURRSTONE RD | ||||||||
| Address2: | |||||||||
| City: | NEW HARTFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134131001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157981720 | ||||||||
| FaxNumber: | 3157981536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2015 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 284301 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
ID Information
| ID | Type | State | Issuer | Description | 284301 | 05 | NY | MEDICAID | 284301 | 01 | NY | LPN | OTHER |