Individual
DR. MATHEW SABU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
462 ELIZABETH AVE, SOMERSET, NJ 08873-5107
(516) 849-5801
Mailing address
870 KALLAS CT, VALLEY STREAM, NY 11580-1517
(516) 849-5801
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
28RI03805700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
064685
LICENSE
NY
01
—
28RI03805700
LICENSE
NJ
Enumeration date
11/30/2020
Last updated
11/30/2020
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