Provider Demographics
NPI:1356645329
Name:ALAN J SACKIN,M.D.,P.A.
Entity Type:Organization
Organization Name:ALAN J SACKIN,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PEARL
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-720-5600
Mailing Address - Street 1:7421 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2977
Mailing Address - Country:US
Mailing Address - Phone:954-720-5600
Mailing Address - Fax:954-720-5603
Practice Address - Street 1:7421 N UNIVERSITY DR
Practice Address - Street 2:SUITE 210
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2977
Practice Address - Country:US
Practice Address - Phone:954-720-5600
Practice Address - Fax:954-720-5603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036330207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79566Medicare UPIN