Provider Demographics
NPI:1346242310
Name:DAVIS, SAMPSON M (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMPSON
Middle Name:M
Last Name:DAVIS
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 1:66 W GILBERT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4918
Mailing Address - Country:US
Mailing Address - Phone:721-212-0060
Mailing Address - Fax:732-212-0061
Practice Address - Street 1:530 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3674
Practice Address - Country:US
Practice Address - Phone:732-442-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07204500207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ34498OtherUHP-NON PAR
NJ9089209Medicaid
NJ064802XZ2Medicare PIN
NJ064802AA7Medicare PIN
NJ064802DLEMedicare PIN
NJ064802A6SMedicare PIN
NJ064802UXKMedicare PIN
NJ064802S6SMedicare PIN
NJH74435Medicare UPIN
NJ064802Medicare ID - Type Unspecified
NJ064802SN3Medicare PIN
NJ34498OtherUHP-NON PAR
NJ064802UWYMedicare PIN