Provider Demographics
NPI:1336305804
Name:VIJAY NARAYAN SAMANT MD PA
Entity Type:Organization
Organization Name:VIJAY NARAYAN SAMANT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:NARAYAN
Authorized Official - Last Name:SAMANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-395-0737
Mailing Address - Street 1:PO BOX 273444
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33427-3444
Mailing Address - Country:US
Mailing Address - Phone:561-395-0737
Mailing Address - Fax:561-395-0766
Practice Address - Street 1:800 SW 15TH STREET
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1340
Practice Address - Country:US
Practice Address - Phone:561-395-0737
Practice Address - Fax:561-395-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043269207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06882910Medicaid
GADO3251OtherR/R MEDICARE
FL06882910Medicaid
FLD63845Medicare UPIN