Provider Demographics
NPI:1861519209
Name:SAKS, MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SAKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4124
Mailing Address - Country:US
Mailing Address - Phone:516-364-6847
Mailing Address - Fax:516-364-0738
Practice Address - Street 1:314 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4124
Practice Address - Country:US
Practice Address - Phone:516-364-6847
Practice Address - Fax:516-364-0738
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010081-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV94511Medicare ID - Type Unspecified