Basic Information
| Provider Information | |||||||||
| NPI: | 1205870631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SABO | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 GRAND ST | ||||||||
| Address2: | FL 3 | ||||||||
| City: | WARWICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109901035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453685000 | ||||||||
| FaxNumber: | 8459875979 | ||||||||
| Practice Location | |||||||||
| Address1: | 99 BEAUVOIR AVE | ||||||||
| Address2: | |||||||||
| City: | SUMMIT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079013533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085222232 | ||||||||
| FaxNumber: | 9085220227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 12/05/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MA61768 | NJ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 223586664 | 01 | NJ | TRICARE/CHAMPUS | OTHER | 223586664 | 01 | NJ | BCBS | OTHER | 6437508 | 05 | NJ | MEDICAID |