Provider Demographics
NPI:1437598851
Name:BEKELE, SABA (MD)
Entity type:Individual
Prefix:
First Name:SABA
Middle Name:
Last Name:BEKELE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 OLD COUNTRY RD
Mailing Address - Street 2:DEPT OF INTERNAL MED MILLS 3RD FL
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2726
Mailing Address - Country:US
Mailing Address - Phone:631-465-6141
Mailing Address - Fax:631-465-1967
Practice Address - Street 1:4422 3RD AVE
Practice Address - Street 2:DEPT OF INTERNAL MED MILLS 3RD FL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2545
Practice Address - Country:US
Practice Address - Phone:718-960-6202
Practice Address - Fax:718-960-3486
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY285896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program