Provider Demographics
NPI:1346483377
Name:ABOLAHRARI, SABA (MD)
Entity Type:Individual
Prefix:
First Name:SABA
Middle Name:
Last Name:ABOLAHRARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 1ST ST
Mailing Address - Street 2:APTA15
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2359
Mailing Address - Country:US
Mailing Address - Phone:151-629-4178
Mailing Address - Fax:
Practice Address - Street 1:260 FIRST ST
Practice Address - Street 2:APT A15
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-294-1784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2514811207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine