Provider Demographics
NPI:1720159916
Name:SABIDO, BENJAMIN A (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:A
Last Name:SABIDO
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 1:44 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5217
Mailing Address - Country:US
Mailing Address - Phone:201-841-2472
Mailing Address - Fax:
Practice Address - Street 1:685 MOUNT PROSPECT AVE # 2FL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3151
Practice Address - Country:US
Practice Address - Phone:973-350-9002
Practice Address - Fax:973-350-9009
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07696900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0027928OtherMEDICAID PROVIDER NUMBER
NJ0027928Medicaid
NJ0083585OtherMEDICAID PROVIDER NUMBER
NJ0121070OtherMEDICAID PROVIDER NUMBER
NJ091084Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NJ0121070OtherMEDICAID PROVIDER NUMBER