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NPI Code Detail

MEDICARE: MR. JEFFREY A. SAGE MS, ATC, CSCS, PES

MEDICARE: MR. JEFFREY A. SAGE MS, ATC, CSCS, PES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer000050-1NY

General Provider Information

NPI Number : 1003959701
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY A. SAGE MS, ATC, CSCS, PES
Provider Business Mailing Address
First Line : 11446 HOWE RD
Second Line :
City : AKRON
State : NY
Zip : 14001-9477
Country : US
Telephone Number : 716-759-1670
Fax Number :
Provider Business Practice Location Address
First Line : 4380 MAIN ST
Second Line : DAEMEN COLLEGE ATHLETIC DEPT
City : AMHERST
State : NY
Zip : 14226-3544
Country : US
Telephone Number : 716-839-8220
Fax Number : 716-839-8434
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2007
Last Update Date : 01/31/2008

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