Provider Demographics
NPI:1295838894
Name:SACKSTEIN, STUART ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:ALLAN
Last Name:SACKSTEIN
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 1:707 WHITE HORSE PIKE
Mailing Address - Street 2:SUITE A4
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201
Mailing Address - Country:US
Mailing Address - Phone:609-641-7727
Mailing Address - Fax:609-641-7769
Practice Address - Street 1:707 WHITE HORSE PIKE
Practice Address - Street 2:SUITE A4
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201
Practice Address - Country:US
Practice Address - Phone:609-641-7727
Practice Address - Fax:609-641-7769
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA42256207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ520380Medicare ID - Type Unspecified
C56684Medicare UPIN