Basic Information
| Provider Information | |||||||||
| NPI: | 1912439225 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SACKS | ||||||||
| FirstName: | MARLA | ||||||||
| MiddleName: | ASHLEY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1106 CHAUCER DR | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156019046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7244938979 | ||||||||
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| Practice Location | |||||||||
| Address1: | 450 CLARKSON AVE | ||||||||
| Address2: | BOX 1262 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182703302 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2017 | ||||||||
| LastUpdateDate: | 03/28/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.