Provider Demographics
NPI:1942203112
Name:SAMBUCHI, GREGORY DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DAVID
Last Name:SAMBUCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4600 MILITARY RD
Mailing Address - Street 2:STE B
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-1338
Mailing Address - Country:US
Mailing Address - Phone:716-297-8709
Mailing Address - Fax:716-297-8719
Practice Address - Street 1:4600 MILITARY RD
Practice Address - Street 2:STE B
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-1338
Practice Address - Country:US
Practice Address - Phone:716-297-8709
Practice Address - Fax:716-297-8719
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1974852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01550361Medicaid
NY00010155801OtherUNIVERA HEALTHCARE
NY0507166OtherINDEPENDENT HEALTH
NY000523628001OtherBLUE CROSS OF WESTERN NY
NY0507166OtherINDEPENDENT HEALTH