Provider Demographics
NPI:1588744148
Name:SAMBAZIOTIS, HERA (MD)
Entity type:Individual
Prefix:DR
First Name:HERA
Middle Name:
Last Name:SAMBAZIOTIS
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 1:2800 MARCUS AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-0000
Mailing Address - Country:US
Mailing Address - Phone:516-437-2020
Mailing Address - Fax:516-437-2019
Practice Address - Street 1:2800 MARCUS AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-0000
Practice Address - Country:US
Practice Address - Phone:516-437-2020
Practice Address - Fax:516-437-2019
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228951207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology