Provider Demographics
NPI:1922300854
Name:SACKS, GORDON B (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:B
Last Name:SACKS
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MEMORY LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2321
Mailing Address - Country:US
Mailing Address - Phone:717-781-4489
Mailing Address - Fax:
Practice Address - Street 1:150 MEMORY LN
Practice Address - Street 2:SUITE C
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2321
Practice Address - Country:US
Practice Address - Phone:717-781-4489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03213237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist