Provider Demographics
NPI:1144621871
Name:SACKIN, ALIZA (DPT)
Entity Type:Individual
Prefix:
First Name:ALIZA
Middle Name:
Last Name:SACKIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BOYDEN PKWY UNIT 1
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2410
Mailing Address - Country:US
Mailing Address - Phone:201-919-7646
Mailing Address - Fax:
Practice Address - Street 1:33 BOYDEN PKWY UNIT 1
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2410
Practice Address - Country:US
Practice Address - Phone:201-919-7646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA016316002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty