Provider Demographics
NPI:1669516498
Name:SACHS, PAUL R (PH D)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:SACHS
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 771
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-0771
Mailing Address - Country:US
Mailing Address - Phone:610-667-2524
Mailing Address - Fax:215-248-9294
Practice Address - Street 1:27 E MT AIRY
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119
Practice Address - Country:US
Practice Address - Phone:215-248-6867
Practice Address - Fax:215-248-9294
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003957L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1269458Medicaid
PASA435487Medicare ID - Type Unspecified
R06950Medicare UPIN