Provider Demographics
NPI:1417154204
Name:MILDRED SABO, MD, LLC
Entity Type:Organization
Organization Name:MILDRED SABO, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:SABO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-458-7111
Mailing Address - Street 1:446 JACK MARTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7733
Mailing Address - Country:US
Mailing Address - Phone:732-458-7111
Mailing Address - Fax:732-458-7188
Practice Address - Street 1:446 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7733
Practice Address - Country:US
Practice Address - Phone:732-458-7111
Practice Address - Fax:732-458-7188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ099261Medicare ID - Type Unspecified