Provider Demographics
NPI:1386611531
Name:JOHN, SABU (MD)
Entity type:Individual
Prefix:DR
First Name:SABU
Middle Name:
Last Name:JOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3002
Mailing Address - Country:US
Mailing Address - Phone:718-282-0801
Mailing Address - Fax:718-282-8284
Practice Address - Street 1:322 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226
Practice Address - Country:US
Practice Address - Phone:718-282-0801
Practice Address - Fax:718-282-8284
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217897207R00000X, 207RI0011X
NY217897-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02801178Medicaid
WV3810004192Medicaid
NY88811LW781Medicare PIN
WVI46336Medicare UPIN
WV3810004192Medicaid