Provider Demographics
NPI:1053398602
Name:SGAMBATI, THEODORE P (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:P
Last Name:SGAMBATI
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 1:33 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-2013
Mailing Address - Country:US
Mailing Address - Phone:201-476-0929
Mailing Address - Fax:
Practice Address - Street 1:2 SEARS DR
Practice Address - Street 2:FLOOR 2
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3539
Practice Address - Country:US
Practice Address - Phone:201-262-2333
Practice Address - Fax:201-262-4515
Is Sole Proprietor?:No
Enumeration Date:2005-12-26
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA055600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5370906Medicaid
NJE58227Medicare UPIN
NJ629228Medicare ID - Type Unspecified