Provider Demographics
NPI:1326082926
Name:SAGALOW, JEFFREY P (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:SAGALOW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 WESTIELD AVE
Mailing Address - Street 2:106
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1644
Mailing Address - Country:US
Mailing Address - Phone:908-351-2020
Mailing Address - Fax:908-351-2021
Practice Address - Street 1:520 WESTIELD AVE
Practice Address - Street 2:106
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1644
Practice Address - Country:US
Practice Address - Phone:908-351-2020
Practice Address - Fax:908-351-2021
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4747152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3443701Medicaid
NJT32076Medicare UPIN
NJ538983Medicare PIN