Provider Demographics
NPI:1427490945
Name:MEDMAX LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:MEDMAX LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SABIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-483-0496
Mailing Address - Street 1:210 PASSAIC ST
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-1355
Mailing Address - Country:US
Mailing Address - Phone:973-483-0496
Mailing Address - Fax:973-483-0497
Practice Address - Street 1:851 MOUNT PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3228
Practice Address - Country:US
Practice Address - Phone:973-483-0496
Practice Address - Fax:973-483-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08869000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ220109Medicare PIN