Provider Demographics
NPI:1336474675
Name:GREGORY D. SAMBUCHI MD
Entity Type:Organization
Organization Name:GREGORY D. SAMBUCHI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SAMBUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-297-8709
Mailing Address - Street 1:4600 MILITARY ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305
Mailing Address - Country:US
Mailing Address - Phone:716-297-8709
Mailing Address - Fax:716-297-8719
Practice Address - Street 1:4600 MILITARY ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305
Practice Address - Country:US
Practice Address - Phone:716-297-8709
Practice Address - Fax:716-297-8719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1974852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1942203112Medicaid
NY1942203112Medicaid
NYG08870Medicare UPIN