Provider Demographics
NPI:1134679525
Name:SAMUEL HS THE MD PA
Entity Type:Organization
Organization Name:SAMUEL HS THE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-343-6916
Mailing Address - Street 1:130 ORIENT WAY STE BB
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2145
Mailing Address - Country:US
Mailing Address - Phone:201-343-6916
Mailing Address - Fax:201-438-4227
Practice Address - Street 1:130 ORIENT WAY STE BB
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2145
Practice Address - Country:US
Practice Address - Phone:201-343-6916
Practice Address - Fax:201-438-4227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA328000207RP1001X
NJ25MA08785100207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty