Basic Information
| Provider Information | |||||||||
| NPI: | 1326204124 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BECKER | ||||||||
| FirstName: | SABRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RABINKO | ||||||||
| OtherFirstName: | SABRA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 538 LITCHFIELD ST | ||||||||
| Address2: | |||||||||
| City: | TORRINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067906669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606268232 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 64 ROBBINS ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067082613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035736263 | ||||||||
| FaxNumber: | 2035736030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2008 | ||||||||
| LastUpdateDate: | 02/12/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 002125 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.