Provider Demographics
NPI:1881640191
Name:SABET, REZA (MD)
Entity Type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:SABET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ANDREA COURT
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5338
Mailing Address - Country:US
Mailing Address - Phone:516-864-1230
Mailing Address - Fax:516-908-4644
Practice Address - Street 1:175 JERICHO TPKE
Practice Address - Street 2:SUITE#204
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4532
Practice Address - Country:US
Practice Address - Phone:516-558-7060
Practice Address - Fax:516-558-7328
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112262207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY09545OtherGHI MEDICARE
NY703371Medicare PIN
NYB88797Medicare UPIN