Provider Demographics
NPI:1396717971
Name:BEBAWY, SAM T (MD FCCP)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:T
Last Name:BEBAWY
Suffix:
Gender:M
Credentials:MD FCCP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:719 N BEERS ST
Mailing Address - Street 2:SUITES 2E & 2F
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733
Mailing Address - Country:US
Mailing Address - Phone:732-264-1001
Mailing Address - Fax:732-264-4495
Practice Address - Street 1:719 N BEERS ST
Practice Address - Street 2:SUITES 2E & 2F
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733
Practice Address - Country:US
Practice Address - Phone:732-264-1001
Practice Address - Fax:732-264-4495
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04909400207RC0200X, 207RP1001X, 173F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No173F00000XOther Service ProvidersSleep Specialist, PhD
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6681506Medicaid
NJ558639PTKMedicare ID - Type Unspecified
NJ6681506Medicaid