Provider Demographics
NPI:1871144220
Name:VAN BUREN, SARAH MASUMI (RN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MASUMI
Last Name:VAN BUREN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 US HIGHWAY 22 W
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-8317
Mailing Address - Country:US
Mailing Address - Phone:908-624-9665
Mailing Address - Fax:
Practice Address - Street 1:1945 US HIGHWAY 22 W
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-8317
Practice Address - Country:US
Practice Address - Phone:908-624-9665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY762494163W00000X
NJ26NR21815100163W00000X
CT153529163W00000X
NJ26NJ01063800363LW0102X
CT16.000474367A00000X
NJ25ME00072901367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health