Provider Demographics
NPI:1841972668
Name:SACKS, JONATHAN PAUL (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PAUL
Last Name:SACKS
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1708 W JARVIS AVE # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-1606
Mailing Address - Country:US
Mailing Address - Phone:773-919-7433
Mailing Address - Fax:
Practice Address - Street 1:1200 NAVY PENTAGON
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20350-0001
Practice Address - Country:US
Practice Address - Phone:703-697-7391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant