Healthcare Provider Details

I. General information

NPI: 1386706265
Provider Name (Legal Business Name): IRA M SACKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SULLIVAN DR
JERICHO NY
11753-1918
US

IV. Provider business mailing address

10 SULLIVAN DR
JERICHO NY
11753-1918
US

V. Phone/Fax

Practice location:
  • Phone: 516-606-8175
  • Fax: 516-935-7952
Mailing address:
  • Phone: 516-606-8175
  • Fax: 516-935-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number106563
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: