Healthcare Provider Details

I. General information

NPI: 1124272885
Provider Name (Legal Business Name): JACQUELINE SAX PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 MULBERRY CIR
STATEN ISLAND NY
10314-3716
US

IV. Provider business mailing address

84 MULBERRY CIR
STATEN ISLAND NY
10314-3716
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-4751
  • Fax: 718-698-4751
Mailing address:
  • Phone: 718-698-4751
  • Fax: 718-698-4751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007318
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: