Provider Demographics
NPI:1174150007
Name:SACKS, TROY THOMAS (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:THOMAS
Last Name:SACKS
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-4528
Mailing Address - Country:US
Mailing Address - Phone:908-380-5235
Mailing Address - Fax:
Practice Address - Street 1:550 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1505
Practice Address - Country:US
Practice Address - Phone:908-522-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA019035002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic