Healthcare Provider Details

I. General information

NPI: 1679670111
Provider Name (Legal Business Name): GERALD F SABOL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WEST KINGSBRIDGE ROAD
BRONX NY
10468
US

IV. Provider business mailing address

1083 BLACK ROCK ROAD
EASTON CT
06612
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-9000
  • Fax: 718-741-4618
Mailing address:
  • Phone: 203-261-0055
  • Fax: 203-261-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number028689-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: