Provider Demographics
NPI:1700062635
Name:SACRESTANO, DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SACRESTANO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 NORTHERN BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5316
Mailing Address - Country:US
Mailing Address - Phone:516-627-5775
Mailing Address - Fax:516-627-6259
Practice Address - Street 1:935 NORTHERN BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5316
Practice Address - Country:US
Practice Address - Phone:516-627-5775
Practice Address - Fax:516-627-6259
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006203213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist