Provider Demographics
NPI:1922048222
Name:SARABU, MOHAN ROY (MD)
Entity Type:Individual
Prefix:
First Name:MOHAN
Middle Name:ROY
Last Name:SARABU
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 1:1 COLUMBIA ST
Mailing Address - Street 2:UITE 300
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3923
Mailing Address - Country:US
Mailing Address - Phone:845-483-0100
Mailing Address - Fax:845-483-0200
Practice Address - Street 1:1 COLUMBIA ST
Practice Address - Street 2:SUITE 300
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3923
Practice Address - Country:US
Practice Address - Phone:845-483-0100
Practice Address - Fax:845-483-0200
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142851208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00710352Medicaid
NY00710352Medicaid
A63908Medicare UPIN