Provider Demographics
NPI:1093785057
Name:SAMRA, ELIAHU (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIAHU
Middle Name:
Last Name:SAMRA
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 1:57 HARBORVIEW W
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1911
Mailing Address - Country:US
Mailing Address - Phone:516-239-3005
Mailing Address - Fax:
Practice Address - Street 1:57 HARBORVIEW W
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1911
Practice Address - Country:US
Practice Address - Phone:516-239-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186240-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01282686Medicaid
NY01282686Medicaid
NY98F121Medicare PIN