Individual
SARAH BOUJIDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1174 ROUTE 112, PORT JEFFERSON STATION, NY 11776-8033
(631) 642-9090
Mailing address
417 45TH ST, LINDENHURST, NY 11757-2318
(631) 747-5587
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
026509
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
026509
NYS LICENSE
NY
Enumeration date
04/29/2021
Last updated
04/29/2021
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