Provider Demographics
NPI:1538157938
Name:SABOORI, MEHRAN (MD)
Entity type:Individual
Prefix:
First Name:MEHRAN
Middle Name:
Last Name:SABOORI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 BROADHOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-4807
Mailing Address - Country:US
Mailing Address - Phone:516-931-0041
Mailing Address - Fax:
Practice Address - Street 1:688 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4911
Practice Address - Country:US
Practice Address - Phone:516-932-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350891952085R0001X
NY2194212085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2733037Medicaid
OH4960643OtherAETNA
OH415030OtherWELLCARE
OH000000224377OtherUNISON
OH5960643OtherAETNA
OH2733037Medicaid
OH751182OtherBUCKEYE
OH415030OtherWELLCARE
OH000000529640OtherANTHEM
OH415030OtherWELLCARE
NY02217292Medicaid
P00465138Medicare PIN
OH2733037Medicaid