Provider Demographics
NPI:1255314639
Name:SABBAGH, ELLIOT (DDS)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:
Last Name:SABBAGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 HOMECREST AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2709
Mailing Address - Country:US
Mailing Address - Phone:646-321-5001
Mailing Address - Fax:718-336-1698
Practice Address - Street 1:3749 82ND ST
Practice Address - Street 2:2ND FL
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7031
Practice Address - Country:US
Practice Address - Phone:718-779-5178
Practice Address - Fax:718-779-8840
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01549128Medicaid