Provider Demographics
NPI:1578716304
Name:SARGON BEBLA MD INC
Entity Type:Organization
Organization Name:SARGON BEBLA MD INC
Other - Org Name:SARGON BEBLA MD INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARBUS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:315-387-2176
Mailing Address - Street 1:1524 MCHENRY AVE STE 370
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4568
Mailing Address - Country:US
Mailing Address - Phone:209-409-8513
Mailing Address - Fax:209-422-3074
Practice Address - Street 1:1524 MCHENRY AVE STE 370
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-409-8513
Practice Address - Fax:209-422-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79656207VF0040X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03060900Medicaid
NY03060900Medicaid
NYH28805Medicare UPIN