Provider Demographics
NPI:1679764187
Name:SOBHY, SAAD GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:SAAD
Middle Name:GEORGE
Last Name:SOBHY
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 1:151 NORTHERN CONCOURSE STE 2
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4066
Mailing Address - Country:US
Mailing Address - Phone:315-425-9094
Mailing Address - Fax:
Practice Address - Street 1:151 NORTHERN CONCOURSE STE 2
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-4066
Practice Address - Country:US
Practice Address - Phone:315-425-9094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200 742208VP0014X
NY200742208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01613758Medicaid
G19443Medicare UPIN
BB6854Medicare PIN