Provider Demographics
NPI:1376564708
Name:SAMBATARO, SIMONETTA (MD)
Entity Type:Individual
Prefix:
First Name:SIMONETTA
Middle Name:
Last Name:SAMBATARO
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 1:36 7TH AVE
Mailing Address - Street 2:STE 411
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6609
Mailing Address - Country:US
Mailing Address - Phone:212-633-1249
Mailing Address - Fax:212-633-2608
Practice Address - Street 1:36 7TH AVE
Practice Address - Street 2:STE 411
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6609
Practice Address - Country:US
Practice Address - Phone:212-633-1249
Practice Address - Fax:212-633-2608
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219345208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02271534Medicaid
NY02271534Medicaid
H60578Medicare UPIN