Provider Demographics
NPI:1669000360
Name:SACKS, ERIC (LPN)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:SACKS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6943 CHRISTI LN
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-3001
Mailing Address - Country:US
Mailing Address - Phone:716-957-4278
Mailing Address - Fax:
Practice Address - Street 1:6943 CHRISTI LN
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-3001
Practice Address - Country:US
Practice Address - Phone:716-957-4278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-29
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338548-01164W00000X
NYP104934164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse