Provider Demographics
NPI:1669565289
Name:SOBHY ELECTRODIAGNOSTIC AND PAIN MEDICINE P.C.
Entity type:Organization
Organization Name:SOBHY ELECTRODIAGNOSTIC AND PAIN MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAAD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SOBHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-425-9094
Mailing Address - Street 1:109 SOUTH WARREN STREET
Mailing Address - Street 2:SUITE 711 STATE TOWER BLDG.
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1798
Mailing Address - Country:US
Mailing Address - Phone:315-425-9094
Mailing Address - Fax:315-425-8970
Practice Address - Street 1:109 SOUTH WARREN STREET
Practice Address - Street 2:SUITE 711 STATE TOWER BLDG.
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1798
Practice Address - Country:US
Practice Address - Phone:315-425-9094
Practice Address - Fax:315-425-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200742208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01613758Medicaid
NYAA0369Medicare PIN
G19443Medicare UPIN