Provider Demographics
NPI:1679863963
Name:SACKS, GERALD E
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:E
Last Name:SACKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 DICKENS ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2407
Mailing Address - Country:US
Mailing Address - Phone:718-327-7219
Mailing Address - Fax:
Practice Address - Street 1:1006 DICKENS ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2407
Practice Address - Country:US
Practice Address - Phone:718-327-7219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist