Provider Demographics
NPI:1275577579
Name:SAMEEN, MOHAMED T (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:T
Last Name:SAMEEN
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:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-0467
Mailing Address - Country:US
Mailing Address - Phone:631-675-9393
Mailing Address - Fax:631-675-9391
Practice Address - Street 1:3400 NESCONSET HWY STE 103
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3327
Practice Address - Country:US
Practice Address - Phone:631-675-9393
Practice Address - Fax:631-675-9391
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY214732207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07141380Medicaid
NY070AN1Medicare PIN
NY2235770Medicaid