1740369776 NPI number — S&RSABAPC

Table of content: (NPI 1740369776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740369776 NPI number — S&RSABAPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S&RSABAPC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUHEIL SABA,MD.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740369776
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 MAIN AVE
Provider Second Line Business Mailing Address:
SUITE 2A
Provider Business Mailing Address City Name:
CLIFTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07011-2266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-772-8878
Provider Business Mailing Address Fax Number:
973-772-8803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 MAIN AVE
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
CLIFTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07011-2266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-772-8878
Provider Business Practice Location Address Fax Number:
973-772-8803
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SABA
Authorized Official First Name:
SOUHEIL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-772-8878

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  MA065307 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 868013 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 23759 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7252404 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1832012 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1K2646 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 875621 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P867741 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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