Provider Demographics
NPI:1982608766
Name:SACKETT, VICTOR MICHAEL III (PT)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:MICHAEL
Last Name:SACKETT
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 COSGROVE DR
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2601
Mailing Address - Country:US
Mailing Address - Phone:516-695-4998
Mailing Address - Fax:516-403-1862
Practice Address - Street 1:14 COSGROVE DR
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2601
Practice Address - Country:US
Practice Address - Phone:516-695-4998
Practice Address - Fax:516-403-1862
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014736-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQC2161Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NY07523GMedicare PIN