Provider Demographics
NPI:1124272885
Name:SAX, JACQUELINE (PT)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:SAX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 MULBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3716
Mailing Address - Country:US
Mailing Address - Phone:718-698-4751
Mailing Address - Fax:718-698-4751
Practice Address - Street 1:84 MULBERRY CIR
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3716
Practice Address - Country:US
Practice Address - Phone:718-698-4751
Practice Address - Fax:718-698-4751
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist