=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770087421
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STUART SACKS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2018
-----------------------------------------------------
Last Update Date | 03/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3701 MARKET STREET 6TH FLOOR, SUITE 640
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19104-5508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-662-2250
-----------------------------------------------------
Fax | 215-615-3995
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3400 SPRUCE STREET
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19104-4206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-349-8310
-----------------------------------------------------
Fax | 215-893-7270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | MD480103
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------