Provider Demographics
NPI:1225050230
Name:SAKS, PAUL (DPM PA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:SAKS
Suffix:
Gender:M
Credentials:DPM PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 AVENEL STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1147
Mailing Address - Country:US
Mailing Address - Phone:732-634-4300
Mailing Address - Fax:732-634-4302
Practice Address - Street 1:415 AVENEL ST STE B
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1147
Practice Address - Country:US
Practice Address - Phone:732-634-4300
Practice Address - Fax:732-634-4302
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ1127213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0856830001OtherDMERC DME#
NJ10 3017800Medicaid
NJF09909OtherHEALTHNET
NJ3017800Medicaid
NJ3017800Medicaid
NJF09909OtherHEALTHNET