Provider Demographics
NPI:1588609291
Name:RABY, SAMIR M (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:M
Last Name:RABY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 COLUMBIA HTS
Mailing Address - Street 2:APT 2E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2170
Mailing Address - Country:US
Mailing Address - Phone:718-855-5498
Mailing Address - Fax:
Practice Address - Street 1:160 COLUMBIA HEIGHTS, 2E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-855-5498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14F081Medicare ID - Type Unspecified
NYD92656Medicare UPIN