Provider Demographics
NPI:1073943429
Name:SADECK, JACOB (PA-C)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:SADECK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1070
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02722-1070
Mailing Address - Country:US
Mailing Address - Phone:508-676-3292
Mailing Address - Fax:508-672-7181
Practice Address - Street 1:901 S MAIN ST
Practice Address - Street 2:PRIMA CARE, PC
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02724-2943
Practice Address - Country:US
Practice Address - Phone:508-673-4329
Practice Address - Fax:508-679-6669
Is Sole Proprietor?:No
Enumeration Date:2013-11-21
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAPA4871363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical