Keith Sakelakos

Primary specialty

OpticianTaxonomy code 156FX1800X

License

31TD00416600 Issued in NJ

Practice address

300 Wootton St
Boonton, NJ 07005-1925

Phone

(973) 299-1730

Fax

(973) 299-1733

NPI assigned

Oct 30, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1316719628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 WOOTTON ST",
            "city": "BOONTON",
            "state": "NJ",
            "postal_code": "070051925",
            "telephone_number": "973-299-1730",
            "fax_number": "973-299-1733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 WOOTTON ST",
            "city": "BOONTON",
            "state": "NJ",
            "postal_code": "070051925",
            "telephone_number": "973-299-1730",
            "fax_number": "973-299-1733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAKELAKOS",
        "first_name": "KEITH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-10-30",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NJ",
            "license": "31TD00416600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Rudowsky
• Javeria Sahib Din, MD
• Saint Clare'S Health System
• Saint Clare'S Hospital, Inc
• Catherine M Saint Jacques, DPT
• Anas Salem
• Mohammed Nasser Salem, M.D
• Phillip Samuel-Siegel, L.C.S.W.
• Gabrielle Fayth Samuels, D.O.
• John Joseph Santoro, MA, LCADC

• Optician in Boonton, NJ
• Providers in Boonton, NJ by specialty
• Optician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.