Healthcare Provider Details

I. General information

NPI: 1104832625
Provider Name (Legal Business Name): GREGORY ROY SABOEIRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST HOSPITAL FOR SPECIAL SURGERY - RADIOLOGY
NEW YORK NY
10021-4872
US

IV. Provider business mailing address

535 E 70TH ST HOSPITAL FOR SPECIAL SURGERY - RADIOLOGY
NEW YORK NY
10021-4872
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1566
  • Fax: 212-734-7378
Mailing address:
  • Phone: 212-606-1566
  • Fax: 212-734-7378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number231021
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number231021
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: