Provider Demographics
NPI:1225439011
Name:FASIHSAMADMDPC
Entity Type:Organization
Organization Name:FASIHSAMADMDPC
Other - Org Name:OSTOMY SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FASIH
Authorized Official - Middle Name:U
Authorized Official - Last Name:SAMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-619-1256
Mailing Address - Street 1:5 E TWIN RIVER DR
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520
Mailing Address - Country:US
Mailing Address - Phone:732-619-1256
Mailing Address - Fax:
Practice Address - Street 1:BLDG5 TWIN RIVER DR
Practice Address - Street 2:APTE
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520
Practice Address - Country:US
Practice Address - Phone:732-619-1256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD8071291U00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No291U00000XLaboratoriesClinical Medical Laboratory