Provider Demographics
NPI:1407855927
Name:SACKSTEIN, ROBERT D (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:SACKSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:112 QUARRY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4816
Mailing Address - Country:US
Mailing Address - Phone:203-333-8800
Mailing Address - Fax:203-333-6054
Practice Address - Street 1:112 QUARRY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4816
Practice Address - Country:US
Practice Address - Phone:203-333-8800
Practice Address - Fax:203-333-6054
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029852207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400135137Medicare PIN
CT110004920Medicare ID - Type Unspecified
CTF27751Medicare UPIN