| Doctor Name: | CARLOS SACRISTAN |
| NPI Number: | 1811971229 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | MA61947 |
| Business Practice Address: | 17-19 Howe Ave Passaic, NJ - 070554017 |
| Business Phone Number: | 9734734399 |
| Business Fax Number: | 9734733039 |
| Mailing Address: | 17-19 Howe Ave, P.o. Box 327 PASSAIC |
| State: | NJ |
| Postal Code: | 070554017 |
| Phone Number: | 9734734399 |
| Fax Number: | 9734734430 |
| NPI Enumeration Date: | 11/30/2005 |
| NPI Last Update Date: | 12/30/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MA61947 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |