Provider Demographics
NPI:1366403172
Name:SGAMBATI, STEPHEN JR (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SGAMBATI
Suffix:JR
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:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12181-0689
Mailing Address - Country:US
Mailing Address - Phone:518-268-5000
Mailing Address - Fax:
Practice Address - Street 1:202 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MECHANICVILLE
Practice Address - State:NY
Practice Address - Zip Code:12118-3530
Practice Address - Country:US
Practice Address - Phone:518-664-6125
Practice Address - Fax:518-664-2851
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00659898Medicaid
C59244Medicare UPIN
NYI77000Medicare PIN