Provider Demographics
NPI:1083632392
Name:SAMANIEGO, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SAMANIEGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CEDAR ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2031
Mailing Address - Country:US
Mailing Address - Phone:914-481-5106
Mailing Address - Fax:914-481-5108
Practice Address - Street 1:33 CEDAR ST
Practice Address - Street 2:SUITE 3
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2031
Practice Address - Country:US
Practice Address - Phone:914-481-5106
Practice Address - Fax:914-481-5108
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY225580-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH95711Medicare UPIN