Provider Demographics
NPI:1962429449
Name:SACK, STANLEY S (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:S
Last Name:SACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1201 WHITE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-3328
Mailing Address - Country:US
Mailing Address - Phone:305-292-0598
Mailing Address - Fax:305-295-0597
Practice Address - Street 1:1201 WHITE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3328
Practice Address - Country:US
Practice Address - Phone:305-295-0598
Practice Address - Fax:305-295-0597
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA59258208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
27232OtherHEALTHY START
784181OtherMVP HEALTH CARE
042472266OtherHEALTHCARE VALUE MANAGEME
042472266OtherUNITED HEALTHCARE
J07967OtherBLUE CROSS
AA1178OtherHARVARD PILGRIM HEALTHCAR
4065772OtherAETNA US HEALTHCARE
J07967OtherMEDICARE B
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTRICARE CHAMPUS
059258OtherTUFTS HEALTH PLAN
MA3031934Medicaid
0068561OtherCIGNA HEALTH PLAN
042472266OtherTHREE RIVERS
9900033OtherFALLON COMMUNITY HEALTH P
042472266OtherONE HEALTH PLAN
27232OtherCHILDRENS MEDICAL SECURIT
919679OtherFIRST HEALTH
042472266OtherHEALTHCARE VALUE MANAGEME
042472266OtherUNITED HEALTHCARE