Provider Demographics
NPI:1477721744
Name:PAUL SAKS DPM,PA
Entity Type:Organization
Organization Name:PAUL SAKS DPM,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM PA
Authorized Official - Phone:732-299-7659
Mailing Address - Street 1:415 AVENEL ST STE B
Mailing Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00112700213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3017800Medicaid
NJ0856830001Medicare NSC
NJ3017800Medicaid