Basic Information
| Provider Information | |||||||||
| NPI: | 1669883245 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SACK | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 FRANCIS ST | ||||||||
| Address2: | ASB-II, GI CLINIC | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021156110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177326389 | ||||||||
| FaxNumber: | 6175660338 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 FRANCIS ST | ||||||||
| Address2: | ASB-II, GI CLINIC | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021156110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177326389 | ||||||||
| FaxNumber: | 6175660338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2014 | ||||||||
| LastUpdateDate: | 08/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0008X | 287611 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology | 207RG0100X | 287611 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RT0003X | 287611 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology |
No ID Information.