Healthcare Provider Details

I. General information

NPI: 1093183543
Provider Name (Legal Business Name): RAPHAEL SACHO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SEAVIEW AVE STE 201
STATEN ISLAND NY
10305-3400
US

IV. Provider business mailing address

125 GOFF AVE
STATEN ISLAND NY
10309-2802
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-4940
  • Fax: 718-226-4945
Mailing address:
  • Phone: 414-514-3895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number1-876
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number1-876
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number310669
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number310669
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: