Provider Demographics
NPI:1205870631
Name:SABO, STEPHEN R (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:SABO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:20 GRAND ST
Mailing Address - Street 2:FL 3
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-368-5000
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:99 BEAUVOIR AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3533
Practice Address - Country:US
Practice Address - Phone:908-522-2232
Practice Address - Fax:908-522-0227
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA61768207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223586664OtherTRICARE/CHAMPUS
NJ223586664OtherBCBS
NJ6437508Medicaid
NJ223586664OtherTRICARE/CHAMPUS
NJ6437508Medicaid