Healthcare Provider Details

I. General information

NPI: 1629587894
Provider Name (Legal Business Name): JESSICA ROSE SACKS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2546 BALLTOWN RD STE 300
SCHENECTADY NY
12309-1079
US

IV. Provider business mailing address

2546 BALLTOWN RD STE 300
SCHENECTADY NY
12309-1079
US

V. Phone/Fax

Practice location:
  • Phone: 518-377-8184
  • Fax:
Mailing address:
  • Phone: 518-377-8184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberOA007681
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.008838RX
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00984600
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.012223
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberTPPA975
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA102271
License Number StateMA
# 7
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number021405
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number021405
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: