Provider Demographics
NPI:1154307502
Name:MUBBASHAR, SABOOH (MD)
Entity type:Individual
Prefix:
First Name:SABOOH
Middle Name:
Last Name:MUBBASHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:104 RUSSO DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-1724
Mailing Address - Country:US
Mailing Address - Phone:203-809-9110
Mailing Address - Fax:
Practice Address - Street 1:64 ROBBINS ST
Practice Address - Street 2:CRISIS INTERVENTION CENTER
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2613
Practice Address - Country:US
Practice Address - Phone:203-573-6500
Practice Address - Fax:203-573-7007
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0436192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTI39020Medicare UPIN