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General NPI Number Information
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NPI Number | 1033872379
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Entity Type | Individual
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Provider Name | JUSTIN VERCELES SABAS NP
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Gender | Male
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 3959 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10032-1559
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Country | US
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Telephone | 212-305-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 112 JOHNSON AVE
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City | TEANECK
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State | NJ
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Zip | 07666-4216
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Country | US
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Telephone | 201-647-5179
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 26NJ01341800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | 350544
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License Number State | NY
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