Provider Demographics
NPI:1669475992
Name:SACKS, HARRY G (DDS, JD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:G
Last Name:SACKS
Suffix:
Gender:M
Credentials:DDS, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 LAKEVILLE RD
Mailing Address - Street 2:STE 204
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1661
Mailing Address - Country:US
Mailing Address - Phone:516-437-2666
Mailing Address - Fax:516-358-6954
Practice Address - Street 1:2035 LAKEVILLE RD
Practice Address - Street 2:STE 204
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1661
Practice Address - Country:US
Practice Address - Phone:516-437-2666
Practice Address - Fax:516-358-6954
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY357761223S0112X
NY0001561223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00906212 04Medicaid
NYT81205Medicare UPIN
1878693-1Medicare ID - Type Unspecified