Healthcare Provider Details

I. General information

NPI: 1104098698
Provider Name (Legal Business Name): MICHAEL J. SACCA, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 UNION BLVD
WEST ISLIP NY
11795-3105
US

IV. Provider business mailing address

580 UNION BLVD
WEST ISLIP NY
11795-3105
US

V. Phone/Fax

Practice location:
  • Phone: 631-321-6801
  • Fax: 631-321-3869
Mailing address:
  • Phone: 631-321-6801
  • Fax: 631-321-3869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number203794
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number203794
License Number StateNY

VIII. Authorized Official

Name: MS. DENISE M. BELLO
Title or Position: OFFICE MANAGER
Credential:
Phone: 631-321-6801