Provider Demographics
NPI:1508827833
Name:SOBEL, SIDNEY HARRY (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:HARRY
Last Name:SOBEL
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 1:200 THACKERY RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-3363
Mailing Address - Country:US
Mailing Address - Phone:585-442-3802
Mailing Address - Fax:585-442-3454
Practice Address - Street 1:200 THACKERY RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-3363
Practice Address - Country:US
Practice Address - Phone:585-442-3802
Practice Address - Fax:585-442-3454
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087891174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00459403Medicaid
NYB75373Medicare UPIN
NY00459403Medicaid