Provider Demographics
NPI:1871826230
Name:EMPIRE MEDICAL II, LLC
Entity Type:Organization
Organization Name:EMPIRE MEDICAL II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:SABIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-350-9002
Mailing Address - Street 1:1085 FRANKLIN LAKES ROAD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1131
Mailing Address - Country:US
Mailing Address - Phone:973-350-9002
Mailing Address - Fax:973-350-9009
Practice Address - Street 1:757 MT. PROSPECT AVENUE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3220
Practice Address - Country:US
Practice Address - Phone:973-350-9002
Practice Address - Fax:973-350-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07696900261Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0212776Medicaid
NJ173498Medicare PIN