Provider Demographics
NPI:1407960529
Name:SABZANOVA, ALLA (DO)
Entity Type:Individual
Prefix:DR
First Name:ALLA
Middle Name:
Last Name:SABZANOVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 STEINWAY ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1875
Mailing Address - Country:US
Mailing Address - Phone:718-423-0808
Mailing Address - Fax:718-204-6866
Practice Address - Street 1:4604 31ST AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-1842
Practice Address - Country:US
Practice Address - Phone:718-545-2100
Practice Address - Fax:718-545-1900
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02802353Medicaid
NYG400000781Medicare PIN
NY01HCSEMedicare PIN