1144332024 NPI number — DR. DAVID M SACKNOFF MD

Table of content: DR. DAVID M SACKNOFF MD (NPI 1144332024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144332024 NPI number — DR. DAVID M SACKNOFF MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SACKNOFF
Provider First Name:
DAVID
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144332024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 WEST CARVER STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-421-0020
Provider Business Mailing Address Fax Number:
631-421-4738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 WEST CARVER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-421-0020
Provider Business Practice Location Address Fax Number:
631-421-4738
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  178807 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 178807 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0C8779 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1336817 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4973454001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 062 . This is a "NEW YORK MEDICAID SPECIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110095209 . This is a "RRMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 178807 . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01573344 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: DS003J4410 . This is a "BLUE CROSS BLUE SHIELD ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 178807 . This is a "MEDICAL LICENSE NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 178807 . This is a "STATE LICENSE #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 394899 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4498664 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 47582 . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: SD8807 . This is a "ATLANTIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0C8779 . This is a "CARECORE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CIM-CVD . This is a "WCB RATING CODE" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y046026 . This is a "CHAPUS ID" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com