Provider Demographics
NPI:1730482225
Name:AMBULATORY INTERNAL MEDICINE CLINIC, PC
Entity Type:Organization
Organization Name:AMBULATORY INTERNAL MEDICINE CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SABA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-270-7200
Mailing Address - Street 1:216 N RIVER ST
Mailing Address - Street 2:SUITE # 650
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2532
Mailing Address - Country:US
Mailing Address - Phone:570-270-7200
Mailing Address - Fax:
Practice Address - Street 1:216 N RIVER ST
Practice Address - Street 2:SUITE # 650
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2532
Practice Address - Country:US
Practice Address - Phone:570-270-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056295L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty