1346256526 NPI number — MARK G SABBOTA DO

Table of content: MARK G SABBOTA DO (NPI 1346256526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346256526 NPI number — MARK G SABBOTA DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SABBOTA
Provider First Name:
MARK
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1346256526
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10650 W STATE ROAD 84
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
DAVIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33324-4235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-382-1550
Provider Business Mailing Address Fax Number:
954-382-1250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10650 W STATE ROAD 84
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
DAVIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33324-4235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-382-1550
Provider Business Practice Location Address Fax Number:
954-382-1250
Provider Enumeration Date:
07/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  OS8452 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 266497600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".