Healthcare Provider Details

I. General information

NPI: 1386882645
Provider Name (Legal Business Name): ALYSSA SACKS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2009
Last Update Date: 01/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 RYDER ST
BROOKLYN NY
11234-4309
US

IV. Provider business mailing address

1744 RYDER ST
BROOKLYN NY
11234-4309
US

V. Phone/Fax

Practice location:
  • Phone: 718-645-5200
  • Fax:
Mailing address:
  • Phone: 718-645-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number5789999
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: