MEDICARE: MIRIAM SABO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		NY

General Provider Information

NPI Number	:	1467716365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM SABO

Provider Business Mailing Address
First Line	:	1062 E 12TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4138
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1062 E 12TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4138
Country	:	US
Telephone Number	:	718-253-8392
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2012
Last Update Date	:	06/26/2012

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Directions to “ MIRIAM SABO ” Practice Location

Language	Start Address	Practice Location

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