Provider Demographics
NPI:1144332024
Name:SACKNOFF, DAVID M (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:SACKNOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WEST CARVER STREET
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-421-0020
Mailing Address - Fax:631-421-4738
Practice Address - Street 1:200 WEST CARVER STREET
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-421-0020
Practice Address - Fax:631-421-4738
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178807207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0C8779OtherHEALTHNET
1336817OtherUNITED
4973454001OtherCIGNA
062OtherNEW YORK MEDICAID SPECIAL
110095209OtherRRMC
178807OtherHIP
NY01573344Medicaid
DS003J4410OtherBLUE CROSS BLUE SHIELD ID
178807OtherMEDICAL LICENSE NUMBER
178807OtherSTATE LICENSE #
394899OtherCONNECTICARE
4498664OtherAETNA
47582OtherVYTRA
SD8807OtherATLANTIS
0C8779OtherCARECORE
CIM-CVDOtherWCB RATING CODE
Y046026OtherCHAPUS ID
Y046026OtherCHAPUS ID
178807OtherHIP
F78481Medicare UPIN