Provider Demographics
NPI:1639231665
Name:PATRICK J. SABO, D.M.D. & MARK A. RIENECKER, D.D.S., P.C.
Entity Type:Organization
Organization Name:PATRICK J. SABO, D.M.D. & MARK A. RIENECKER, D.D.S., P.C.
Other - Org Name:ROBERT J.GOLDMAN, D.D.S., ELLIOT S.TAYNOR, D.D.S., P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SABO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:631-399-1600
Mailing Address - Street 1:6 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1594
Mailing Address - Country:US
Mailing Address - Phone:631-928-2655
Mailing Address - Fax:631-399-1014
Practice Address - Street 1:6 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1594
Practice Address - Country:US
Practice Address - Phone:631-928-2655
Practice Address - Fax:631-399-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0488121223X0400X
NY0466711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03260964Medicaid