Provider Demographics
NPI:1033150164
Name:SACCO, CHARLES DAVID (MSPT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVID
Last Name:SACCO
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 S WHITE HORSE PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-1973
Mailing Address - Country:US
Mailing Address - Phone:856-809-9001
Mailing Address - Fax:856-809-9003
Practice Address - Street 1:289 S WHITE HORSE PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-1973
Practice Address - Country:US
Practice Address - Phone:856-809-9001
Practice Address - Fax:856-809-9003
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00817900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist