Healthcare Provider Details

I. General information

NPI: 1073582011
Provider Name (Legal Business Name): MICHAEL ANTHONY SBARRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE SUITE 705
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

20 PROSPECT AVE SUITE 705
HACKENSACK NJ
07601-1997
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-0409
  • Fax: 201-488-8333
Mailing address:
  • Phone: 201-488-0409
  • Fax: 201-488-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMA55044
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMA55044
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierJ29768
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerACS HEALTHNET
# 2
IdentifierP2093898
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerOXFORD
# 3
Identifier507533
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAETNA
# 4
Identifier1226498
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerUNITED HEALTHCARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: