Provider Demographics
NPI:1225034887
Name:CARUTHERS, SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:CARUTHERS
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:P.O. BOX 429
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1119
Mailing Address - Country:US
Mailing Address - Phone:862-222-4629
Mailing Address - Fax:973-352-9519
Practice Address - Street 1:408 MAIN ST STE 101D
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1799
Practice Address - Country:US
Practice Address - Phone:862-222-4629
Practice Address - Fax:973-352-9519
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217213207L00000X, 207LP2900X
NJ25MA07863200207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402459100Medicaid
MD402459100Medicaid